By Catherine Aquino, Vice President Sales, Consumer & Small Business Markets, Independent Health

Most employees who’ve never had to think about Medicare while they’re working will have to consider their options once they decide to retire at age 65. And, because  most employers don’t offer retiree health coverage, we receive questions from people wondering what their options are once they close out their careers for good.

In this article, we’re covering some of the most common questions from individuals wondering about Medicare and what they should do.  

Most people become eligible for Medicare once they turn age 65, unless they have a qualifying disability or other situation at a younger age.  They have two Medicare options: Original Medicare, which has two parts, A and B, or a Medicare Advantage plan (known as Part C).  Along with Original Medicare and Medicare Advantage are many choices: prescription drug coverage (Part D), supplemental coverage and more.  To decide which is right for them, they’ll need to do some homework.

First, here’s a quick overview of each:

Original Medicare

Offered directly through the federal government, this is available at no cost to people who have worked, or whose spouse has worked, for at least 10 years and have paid Medicare taxes through their employer. 

Part A has no monthly premium and covers inpatient hospital stays, skilled nursing facilities, hospice, and some other skilled care. Part B has a monthly cost based on income and covers care received in doctors’ offices, outpatient care, and other medical services, like preventive care, that Medicare Part A doesn’t cover. 

Medicare Advantage

Medicare Advantage plans (also known as Part C) are private health plans that usually cover more services and have lower out-of-pocket costs than Original Medicare.  Every insurance company that offers these plans has a contract with the federal government that is renewed annually. 

Medicare Advantage plans are responsible for paying the members’ claims.  Members pay other plan costs, such as copays, coinsurances, etc.).  These plans may also have a monthly premium. Some Medicare Advantage plans include drug coverage, which is known as Part D. 

Medicare Supplemental Policies

These policies are also known as “Medigap” plans.  They cover some or all of the expenses not covered by Parts A and B.  People who choose Original Medicare may want to have a Medigap policy, which has a premium based on the plan selected.

As people consider their next steps, here a few questions we receive from people planning to retire:

When can retirees sign up for Medicare coverage?

Individuals aging into Medicare can sign up for Original Medicare or a Medicare Advantage plan as early as three months before they turn age 65.  The local Social Security office is the place for them to enroll in Original Medicare.

Is Original Medicare enough coverage?

Having Original Medicare likely isn’t the best option because it doesn’t cover everything.  A Medicare Advantage or Supplement offers wider coverage. Whichever plan an individual chooses, it may have copays, coinsurance, deductibles and other payments. 

After I choose a Medicare plan, how often can I change plans?

Like commercial coverage, plan choices are not permanent. Enrollees have an opportunity to change plans as of January 1 each year.  There are exceptions known as “special election periods” but these are based on eligibility.  In addition, 5-Star Medicare Advantage Plans offer continuous enrollment throughout the year to current enrollees of other plans.

Do Medicare plans offer gym and fitness benefits?

Medicare Advantage plans typically offer benefits above and beyond Original Medicare, including benefits such as gym memberships. As with commercial coverage, benefits vary by plan and by the insurance company offering the plan. 

What if I decide to work beyond age 65; can I keep my current coverage while I’m working?

It depends on your employer, but most will allow their employees to continue group coverage past the age of 65. If your employer has more than 20 employees, Medicare allows you to defer enrolling in Medicare Part B until you truly decide to retire. You are considered an “extended age-in” where you are past the initial age (65) when most people can age-in/pick up Medicare Part B and enroll in a Medicare option.

We are here to help

Independent Health has several Medicare Advantage options for individuals to choose from.  It can be daunting for individuals retiring to figure out their options. We can help. People can start by contacting us here or visiting us at one of our Medicare Information Centers. 

Photo by Diane Parkhouse on Unsplash