Info For Making The Move
Typically, when one turns 65, they go onto Medicare and leave their group of individual coverage. That is the old model. Today, as seniors continue working beyond 65, they typically fall into two categories.
1. Those working for a company with more than 20 employees. They can keep their group insurance and only apply for Part A (Which is in hospital services and has no monthly premium.) They defer Part B to when they retire. Meaning their group coverage pays first and Medicare pays second. So, when you are hospitalized, your group coverage pays first, and Medicare pays 2nd thus lowering your overall cost of that hospitalization.
2. Working for a company with less than 20 employees is the opposite because Medicare pays first, and your group coverage pays second. Therefore, you must take Medicare Parts A & B
Many seniors working for companies with less than 20 employees do not understand the rules and listen to friends and neighbors who think they know the answers. I can’t begin to tell you how many seniors over the years have made this mistake. That mistake costs them a 10% penalty on the current monthly Part B premium and those premium increases annually. This is a lifetime fine, and it increases as Part B premium increases.
As you can see, making a mistake while signing up for Medicare can be a very costly one. Many seniors cannot afford these lifetime fines, and CMS does not allow those fines to be abated.
The simplest way to avoid this is to seek help from a licensed Medicare broker. Our services are at no cost to the senior and CMS has seen to it that all the MAPD plans pay the same commission so we cannot steer you to one plan because they pay higher commissions. I believe this is a fair way of handling the complexities of Medicare and the benefit to the senior is multifold.
Getting the best plan for you based on your doctors and medications is the proper way to evaluate a senior’s needs and provide them with the best plan for them at the time. There are 84 different plans in Southern Nevada which is a daunting task for most seniors to evaluate and decide the best plan to choose. Each plan has their strong points and weak points so knowing those can help a senior to get the best plan they can. As a senior myself, evaluating takes time and an understanding of Medicare. Picking the wrong plan is a health risk. Seek help and get it right the first time. You can always change plans twice annually after your initial enrollment. You have the
Annual Election Period which starts on October 15 and runs until December 7th each year. Any plan you choose during that time starts on January 1st of the following year. You can change plans as many times as you want during that period with the last one chosen starting on January 1st of the following year.
You also have the Open Enrollment Period from January 1st through March 31st.where you can change your MAPD (Medicare Advantage Prescription Drug) one more time and you must stay on that plan until 12/31 of that year. You cannot change any standalone drug plans during the Open Enrollment Period, and I am at a loss to understand why. If I can change an MAPD plan which includes drugs why can’t, I change my standalone drug plan during that same time? A question that Congress needs to answer. Remember, Congress is not on Medicare so most have no idea of the complexity of the issues.
The Medicare Supplement market is quite different from the MAPD one. Medicare Supplements are private insurance with no governmental subsidy like MAPD plans. Once you purchase a Medicare Supplement the only time you can change that plan or go to another insurance carrier is by using the Nevada Birthday rule which I authored, and it allows you to change your supplement plan the month of and the month after your birthday with guaranteed issue, meaning no underwriting. I used the birthday rule in 2024 and kept the same plan but with a different insurance carrier and saved over $100.00 per month. Also helped many of my clients do the same thing and they’ve each saved about $100 per month.
We’ve covered all the Medicare options except just having Original Medicare and a standalone drug plan. While it appears to be a good idea, it is not and can cause a senior severe financial headache. Original Medicare is the only insurance the United States that does not have a maximum out-of-pocket. Meaning you are on the hook for 20% of the bill regardless of how high it is. If you have a $400,000 bill you owe $80,000. Not a pretty picture.
As you can see, the type of Medicare coverage you have determines the financial risk. MAPD plans or Medicare supplement plans eliminate most of the risk and depending upon your personal circumstances either one is a great choice. As an example, to help you understand, my wife has an MAPD plan which she loves, and it has no monthly premium. I have a Medicare Supplement because I have Rheumatoid Arthritis and require an injection monthly done in the doctor’s office which costs $4,000. My supplement along with Medicare picks up the entire amount. If I had an MAPD plan I’d have to pay 20% of the cost as the service falls under Part B drugs, not Part D. So,
for me, even though there is a monthly premium for the supplement I am way ahead on that plan versus the MAPD plan. That is why I recommend you seek the services of a licensed Medicare broker who has the knowledge to help you get the best plan for your needs.
As you can see, transitioning onto Medicare is complicated and seeking assistance to help you navigate what I call “The Medicare Maze” is warranted. As stated previously, it is complex and the pitfalls are many so for peace of mind, get the support of a Medicare broker to make sure you get the best plan for you. Medicare and insurance plans change annually so I’d review my options every couple of years to make sure I have the best plan for me and that is piece of mind. I just had a call from a client who has a Medicare Supplement and that particular plan has had several price increases over the past several years. We are meeting to review her current plan, and I have already found the exact plan from a different insurance company where the monthly premiums are almost $200 per month less.
This blog can provide some insight into the complexities of Medicare and the benefits of checking every couple of years to make sure you have the best plan for you and that the monthly premiums are reasonable. Your health changes so should your insurance, so it meets your current medical needs.
I hope this information is useful and if anyone has questions, please contact me via phone or email and I will respond quickly.
Also, take a look at Medicare 2025 Information.
The Barend Agency Inc.
Len Barend, Broker
Cell:702-250-2200
Email: len@insurance4unevada.com