Medicare madness: Ready for the chaos? 

The Medicare annual election period begins on October 15, 2019. You, our colleagues in the group benefits space, have different start and end dates that are heavily skewed towards the fall, as well, so we share mutual headaches!

Our firm handles only Medicare. While we may say “only” Medicare, it’s an enormous task. We coach people from the time they reach age 64.5 with questions like “Do you need or want Medicare coverage? How does it compare to your employer plan? How much will it cost you? Are you contributing to a health savings account? Should you enroll into Part A only?” And on and on.

Related: As the U.S. workforce gets older, Medicare assistance is a must-have 

Once the answer becomes “Yes, I want or need Medicare coverage” (regardless of age), our work pivots to educating that consumer about pricing, coverage choices, timing of the process, how to work with human resources to avoid Medicare penalties, and more.

The aging workforce leads “Medicare people” like us to become more integrated with the employer benefits space, and we have more interaction with human resources these days. There’s much more confusion as the average employee tries to navigate the intersections of Medicare eligibility and working past age 65.

We’ll provide some trigger topics for you this fall as well as a couple of resources to make your life easier. And, the resources can be passed along to your human resources friends, which will make their life easier, as well. It’s always nice to give them something of value, right?

Employer plans and the health savings accounts 

This one slips through the cracks rather often. I recall talking with two physicians, both age 69, who both enrolled for Part A of Medicare at age 65 and had been fully funding their health savings account ever since. A real no-no. Their financial advisor was on the call with us, as well, and you know that he surely learned something during the phone session. (My guess is that won’t happen again to his clients).

Medicare Part A is not a high-deductible plan, which thus disallows a person from contributing to a health savings account. However, there’s more to that conversation in terms of which person is the employee, are they funding the family level, missing the over age 55 catch-up provision and more.  So, to avoid extra confusion in this short article, let’s just say that the entire health savings account and Part A should be a conversation.

What you can do? Simply say “This really requires you to talk to other advisors as well, Mr. Smith, since you are turning 65 and in an HSA compatible plan.” 

Recently eligible for Medicare

Let’s say you have a person on an employer plan who recently turned 65. The person is not married, and has no other dependents on the plan with him. This employee will typically have no understanding that due to his Medicare eligibility, he can compare that coverage to his employer group coverage.

We often have calls with people who are very healthy, still working, like their employer coverage (they’re healthy and not using it, so of course it’s great, right?), the employer is contributing 80 percent towards the premium. Life is pretty good. We’ll typically advise them to stay with the employer plan as it is in their best interest.

On the flip side, let’s say we have a person struggling with a chronic illness and they can’t go to a certain physician as he/she is out of network with the employer plan. This person can compare coverage, costs, networks or lack thereof, to Medicare’s options.

What you can do? Tread lightly here. Find people who can truly educate the consumer about their choices. We’ve seen people at age 89 stay with employer insurance because they thought they had to.

Under 20 employees 

When an employer size is under 20, Medicare becomes primary coverage for all employees age 65+ who are eligible for Medicare. We find that this one slips through the cracks too often. The employee (and/or their spouse) must enroll into Medicare Parts A and B.

We’ve seen cases where the employee was not made aware of the situation, did not enroll into Medicare, and when the claims rolled in, they were denied. Not all plans will deny; however, some will. This is also an area where it’s a bit gray in terms of who should have told the employee that they needed to enroll into Medicare. It can become a finger-pointing routine and at the end of the day, the consumer/employee is left holding the bag. Don’t let that be your client. At the end of the day, we’re all (as a group) responsible to help them.

What you can do? Find a good Medicare source to verify and triple check situations. For the most part, this only requires a phone call.

The examples above are just a few of the stickiest and most common things that we see as we work with the employer space. To avoid these problems, we must work together as an industry and rely on the experts around us.

Wishing you luck and sanity this season!

Joanne Giardini-Russell is a Medicare specialist and owner of Boomer Health Group in Brighton, Mich., an independent provider of Medicare products nationally. Joanne may be contacted at joanne.giardini-russell@innfeedback.com.