Now today's topic is
who really needs Medicare?
Welcome to Medicare School Daily,
where we help you understand Medicare, save money, avoid making Medicare
mistakes, and above all else, get the most out of your Medicare benefits.
Now, we all know that we're eligible for Medicare at 65, but some people really
don't have to go on Medicare at 65, some must, but some do not have to.
So let's talk about who really needs to go on Medicare at
65. Number one, if you're turning 65 and you're covered by an employer,
provided plan, that means an active employer provided plan.
Now, that could be you're the one working.
Or your spouse is the one working.
But if you're covered by an active employer provided plan,
you may not need Medicare.
If that employer group has 20 insureds or more. Medicare
considers any kind of a group of 20 or more as a large group.
If the group is 19 or less, you'll see that you have to go on Medicare.
But if the group has 20 insureds or more, you may not need to go on Medicare.
You don't have to take A or Medicare B, there will be no penalties
or, no consequences if you're covered by this large group.
So you may not need to, especially if you are satisfied with the coverage.
In other words, you like the network you're in
and you like the way the insurance works.
So you're happy with your co-pays,
you're happy with your co-insurance, and you're happy with the
the deductible and the premium and all the financial aspects of that plan.
If you're satisfied with that coverage and is in a group of 20 or more,
you don't have to do anything with Medicare.
Thirdly, if others are covered by your plan,
in other words, if you have a spouse or maybe children
that are covered by your plan and they have no other insurance options,
you're probably going to want stay on that plan at work.
It just makes sense to do so because now they're going to have to go out
and find their own insurance.
And if they can't do that, then you're going to put them
in a very difficult situation.
OK, so the whole point is
if you're turning 65 covered by an employer provided plan
20 or more, you don't have to do anything with Medicare
if you're satisfied with that coverage.
Now, if you're turning 65 covered by an employer provided plan,
you may need Medicare if these conditions exist.
Number one, if you're dissatisfied with the coverage
some employer plans really just don't have good insurance.
In other words, the plan they put together maybe could be limited on network,
maybe it has a high deductible and there's a lot of things about that
plan that just really are not serving your best interests.
So if you're dissatisfied with that coverage,
you actually can go on Medicare, even if the group is 20 or more.
You can say no to the group plan and you can say yes to Medicare
if indeed you're dissatisfied with that employer option.
Secondly, if you're dissatisfied with the cost of the plan,
meaning it's a very high premium and it has a high deductible
and you don't have really any coverage until you reach that deductible.
So if that thing does not make financial sense, again, you can say no
to the employer provided plan and you can say yes to Medicare.
So if you're dissatisfied.
And then thirdly, if you can save money
now people call us all the time we would like to know,
should I go on Medicare while I'm still working?
Well, maybe, maybe not.
So what we have to know and what you need to know to really make this decision,
if you should go on Medicare, why are you still working?
Number one, is this
what is the premium that you're paying and what's it costing you?
They're probably taking some money out of your check to cover the the premium.
So what is that cost?
Number two, do you have a deductible and do you ever meet that deductible?
So what's the cost of meeting that deductible?
Thirdly, what is your coinsurance are you on an 80/20 plan or a 90/10 plan.
So once you've met the deductible,
most people go into co-insurance and then what is the max out of pocket
that you would spend in any given year, in other words
if you got cancer something serious happened to you,
would it cost you 10,000 or 15,000?
But I'd like to know that and we also have to look at the medications as well.
The whole point is we're looking at all the aspects of that coverage
and then we look at the employer plan and we compare that to Medicare
and there are some times you actually can save money.
So it makes financial sense to go on Medicare.
Now keep this in mind.
If you're married and husband and wife are both eligible for Medicare,
there's two things that we like to know about your premium.
What is the employee only price and what is the employee plus spouse
price? Had a case just recently.
We had employee only price.
If the employer was the only one covered by the plan of $100, a month.
But once that gentleman
added his spouse to the plan, his wife, the premium jumped up to 500 a month.
So it was costing him $400 every month to cover her. Well,
medicare has a much better value than that.
So my advice to them and what they did is we kept him on the employer plan,
at $100 a month and put her on Medicare.
They saved money. They actually had better insurance.
OK, so Medicare may make sense if you're not happy with the cost
I have with the coverage and indeed you can save some money.
All right.
So that's turning 65 covered by an employer provided plan of 20 or more.
Those are your options.
Now let's say you're turning 65 who must go on Medicare because
some of you are going to have to go on Medicare.
You have no other options.
And so here's the scenarios.
If you're in an employer group that has less than 19 insureds remember
20 or more you don't have to do anything with Medicare but 19 or less.
What happens is you have to go on Medicare A and B because in a small group
like this Medicare is the first payer
and your group plan if you keep that will be in the second payer position.
Now there are some consequences that many people decide
if they are in a small group of 19 or less.
It's better to go on Medicare completely and either get a supplemental plan
or an advantage plan and just say no to the group, to the group plan.
But if you're 19 or less, you've got to go on Medicare
A and B because Medicare pays first and then your group plan
or a supplemental plan or something else is going to pay second.
So in a 19 or less,
you've got to go on Medicare secondly, if you have no employer plan available,
which means you or your wife or spouse or husband or you're no longer working
and you don't have an employer option, you have to go on Medicare.
This is a
group of people that must go on Medicare if there's no employer option available.
And what I mean by that is active employment.
You've got to go on Medicare.
Anyone that's on a retiree plan.
Now, many retiree plans will get you to 65.
Some will take you beyond 65.
But the reason you got to go on Medicare at 65 if you're covered by retiree plan
is because that retiree plan will only pay second once you're Medicare eligible.
So you have to enroll in a Medicare and take that Medicare benefit
to Medicare in the first payer position and the retiree plan will only pay second.
Yes it's paid first up until Medicare eligibility.
But after that it will no longer do that it only pays second.
So you've got to be enrolled in Medicare.
If you're on a COBRA plan again, COBRA plans may be getting you to 65.
Cobra plans normally last for about 18 months.
Some situations 36 months.
But if you're turning 65 and we have no employer plan option
but we're covered by COBRA again, you're going to have to go on Medicare A
and B, and the reason for that is very much like the retiree plan.
COBRA only pays second to Medicare.
Now sometimes it does make sense to keep that COBRA
for a short period of time, especially if someone's pet else is paying for it
and the employer's paying for it.
But you only want to keep that for a certain period of time.
But you've got to enroll in a Medicare 65 because Cobra only pays second
to Medicare no longer in the first payer position.
So you got to enroll into Medicare to make that happen.
And then also if you're on an ACA plan, the Affordable Care Act plan.
So you went through the exchange or you had someone help
you go through the exchange and you have an individual plan
that was through the federal marketplace.
And again, there's no reason to keep those plans once you're Medicare eligible.
Now, they say technically you could, but the tax subsidies go away,
the cost sharing goes away.
So there's no reason that I've ever seen for someone to keep an ACA plan
once they're Medicare eligible.
So again, you're going to have to go on Medicare if you're covered by an ACA plan.
And then lastly here, if you have no insurance, certainly
if you have no insurance, you're ready to go on Medicare.
You're going to take it now because now you have these opportunities to be able
to get supplemental plans, advantage plans and drug plans.
And so you've gone without insurance. But now we're Medicare eligible.
It's going to be very, very affordable and really excellent insurance.
So this is turning 65.
You must go on Medicare.
You got a group plan 19 or less.
No group plan whatsoever.
Retiree plans, COBRA plans, ACA plans, and certainly if you don't have insurance.
And then lastly, what happens, though, if you don't start Medicare
at the right time in other words, if you should start at 65
and you don't do so, what are the consequences of doing that?
First off, you're going to go without insurance.
Now, listen, for a young person 20 or 25 years old to go
without insurance, probably not a lot of risk.
I would recommend it, but there's not a lot of risk with that.
But those of us, I'm almost 62 years old, pretty risky
to do that, those of you watching this probably getting close to 65.
And so when we don't start Medicare at the right time when we should, now
we're going to run this risk of being without insurance
and really at our age is simply too risky to do that.
Secondly, your enrollment opportunities are going to be limited
if you have to start at 65.
We call that the initial enrollment period
and that period of time only lasts for seven months.
And so what happens if you don't go on Medicare when you should?
Medicare will allow you to come in later.
But here's the problem you will only be eligible
for what is called a general enrollment period.
And that enrollment period only lasts for three months, a year.
That's the first three months of the year.
But also what happens then your coverage for enrollment into Medicare
will be delayed.
So we enroll the first quarter of the year,
but we don't start our coverage until July one of that same year.
So if we don't go on when we should, we're without insurance.
But now our enrollment opportunities are very limited.
That's called the general enrollment period.
And then lastly, when we use a general period,
you're going to have enrollment penalties that are going to be applied for.
Every year
we go with out, we have a 10% penalty that's added to the Part B premiums.
And for every month we go without a drug plan, they add 1%
every single month to the cost of our Part D plans.
And so we're certainly going to have to have penalties if we go without Medicare.
So these are the scenarios.
So as you're approaching 65, you need to decide, do I have to go on Medicare
or is that an option that I can delay if I have an employer provided
plan of 20 or more people, or is it something I must do now?
So we want to make sure that you want Medicare at the right time.
Hey, thanks so much for watching the video,
and I do hope that it was helpful.
Now if you feel like
you need to learn more about Medicare
to make sure you're making the right Medicare decision,
really the best way and the easiest way to do
that is to go to MedicareSchool.com.
That's MedicareSchool.com,
and you'll be given the opportunity to be able
to click on Get the Free Workshop.
We call that the essentials workshop
and I do all the teaching.
And there you'll learn all the ins and outs of Medicare
to make sure that you have an accurate
and thorough understanding of how Medicare works.
The second thing you can do
is click where it says, talk to a Medicare guide,
and there
you can actually set up a time
where you can discuss your situation
with a Medicare guide.
They'll explain all your options
and actually even walk you
through the enrollment process as well,
if that's what you need to do.
And so go to MedicareSchool.com,
watch the workshop or talk to a Medicare guide.
It would be our privilege to assist you further.