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5 Key Considerations When Switching to Medicare

1610 S 2 When Switching From Employer Medical Insurance - 5 Key Considerations When Switching to Medicare

When you are switching from your employer’s medical insurance to Medicare, being prepared is key.

#1: Medicare is about you and ONLY you.

While many employee medical plans offer coverage for the worker and the spouse, Medicare is per individual… each person is required to have their own Medicare plan. With differing health conditions each person will likely end up with quite different Medicare policies and potentially supplemental insurance.

Have a spouse that doesn’t qualify for Medicare? You’ll have to find separate coverage for them as well.

# 2: Cap? What cap?

Most employer plans (and plans purchased in the insurance marketplace through the Affordable Care Act) have limits on out-of-pocket healthcare expenses you’ll be expected to pay each year. Standard Medicare pays 80% of covered costs and there’s no cap so you could face quite a big bill at a time when your cashflow could be limited. To help, there are Medicare Advantage andMedigap policies with out-of-pocket caps. Exploring your options around these areas is crucial to ensure you’re adequately protected.

#3: Strategically leverage your benefits

Take the time to understand the pros & cons of each type of coverage… what you may currently have and what you’ll be getting under Medicare. If there are medical procedures you are entitled to under your employer’s plan where it is of greater financial benefit for you to take advantage of your current benefits before switching over to Medicare, it’s wise to schedule and take care of those treatments before you switch to Medicare.

Interestingly, sometimes the opposite is true and you might find better benefits under Medicare depending on the treatment. That’s why it is so important to clearly understand your options well before you find yourself transitioning from employer-offered insurance to Medicare.

#4: Medicare is about wellness

Medicare places an emphasis on helping individuals cope with chronic health conditions. It also tends to offer more personal care options while many company sponsored health plans have attempted to cut costs by compelling initial care by phone.

Be sure to check with your HR department on your existing benefits vs. what you should expect to see with Medicare. You may find that Medicare offers a better overall care experience as you age.

#5: Say yes to Part D.

While employee health benefits often include prescription drugs as a part of the plan, with Medicare you’ll need Part D coverage. There are many plans available and for this you’ll rely on private insurance. Shop around to find a plan that offers the price and benefits you need. One tip: Be sure to include the total cost of Part D coverage + your expected costs of medication to get an accurate view of which Part D plan is truly best for your situation.

Your financial advisor should be able to give you some helpful insights as you face these difficult issues. And for a great extra resource, check out “How to Navigate Medicare Plans” ( ) featured on Time’s website.


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