Stay Or Go off Employer Health Plan?

Written by: Dave Majher | Last updated August 7, 2020

More and more people are continuing to work past age 65.  The question then becomes, do I stay on my company health plan and delay Medicare or get Medicare when I turn 65?

To answer that many other questions have to be answered first.

Where do you work?  Rule of thumb is if your company has 20 or more employees you don't have to get Medicare Part B but less than 20 employees you will have to get Medicare Part B.  Either way you should contact your company Human Resource Director to make sure.  By staying on the company health plan you can delay taking Medicare Part B and paying the current monthly premium of $144.60.  However If your company has less than 20 employees at your work and your company requires you to get Medicare Part B when you turn 65 then you definitely should look into your other options with Medicare.  

Does your Spouse and Children need to be covered too?  If your Spouse is under 65 and on your current health plan then it might be best for them to stay on it as the cost for them would be greater to come off your health plan.

Monthly Premium? - How much are you paying every month in premium vs what you would pay for Part B Medicare and a Medicare Supplement or Medicare Advantage Plan?  See below...

 

Deductible? - Do you have a deductible at work that has to be paid before the plan pays?  A Medicare Supplement Plan like Plan G or N can have a low deductible of $198 for the year. Many Medicare Advantage Plans have no deductible at all.

Out of Pocket Maximum? - Do you have a out of pocket maximum at work that once is reached your done paying for the year?  A Medicare Supplement Plan like Plan G or N has no out of pocket maximum for the year. Medicare Advantage Plans out of pocket maximum for the year range from $3,000 to $6,844.60 depending on plan chosen.

Prescriptions? - Do you take some costly prescriptions.  Employer plans for the most part cover costly prescriptions better than stand alone Medicare RX plans or Medicare Advantage Plans that include prescriptions.  You need to make sure what the cost difference is before leaving for an RX plan that won't cover you as well cost wise.  Contact an agent that can run your prescriptions and see how they compare on different plans.

Extra benefits like dental, or vision? - Is dental and vision included with your current work health plan and would you lose them by coming off?  Many Medicare Advantage Plans come with dental and vision as an extra bonus.

Every company health plan can be anywhere from very good to very bad or somewhere between.  Below we show you what other choices you have in coverage and cost when compared to your present company health plan.

Rookie FACT:  The most important thing is weigh all your options, don't assume that because your co-worker stayed on the company plan you have to as well.  We have seen people pay both Medicare Part B premiums and company health plan premiums when they could of saved a lot of money.  They just did not know they had options.

 

Medicare Part B $144.60 Premium

Medicare A Hospital is free for most people if they are eligible for Social Security or Railroad benefits.  Medicare Part B has a monthly premium of $144.60.  It could be higher if income is higher than $87,000 for single or $174,000 for married couple.  You can just get Part A and not Part B if staying on company health plan.  You would not want to get Part A if your still contributing to HSA Health Savings Account at work as Part A does not allow you to continue to participate in HSA's.

If you have to get Medicare Part B to stay on your companies health plan then you should look into coming off your company plan and picking up a Medicare Supplement and RX plan or a Medicare Advantage plan that comes with RX.

If you can delay getting Medicare Part B and stay on your company health plan you still have to weigh your current premium, deductible and out of pocket maximum along with Spouse, Children or extras like dental.

Medicare Supplement Plan

A Medicare Supplement plan premium is determined by gender, age, zip code and plan letter chosen.

Plan G and N are the most popular plans since Plan F is no longer available to individuals turning 65 in 2020 or after. 

Stand alone Prescription Plan

A Prescription plan premium is determined by the plan you choose in your State.  

If someone does not take prescriptions they would look for the RX Plan with the lowest monthly premium.  If someone takes a lot of prescriptions they would want to find the RX Plan that gives them the lowest overall cost for those drugs. 

Medicare Advantage Plan with Prescription Plan included

Medicare Advantage Plans can start at $0 monthly premium and go up from there.  They come in HMO and PPO plans and vary depending on what is offered in your area.

 

Bigger cities with more dense populations with many hospitals are more often to have them available vs rural areas.

These plans are a pay as you go type plan and involve co-pays and co-insurance. They do have out of pocket maximums starting at  $6,700 or less for the calendar year.

Option 1: Medicare Part B and adding a Medicare Supplement Plan G or N and stand alone RX plan premium.  For example the lowest Plan G monthly premium In Cuyahoga county for a Male age 65 is $110.69.  The only thing Plan G does not pick up from Medicare is the one time a year doctor deductible of $198.  The lowest monthly premium RX Plan for Cuyahoga county is $13.80.

 

$144.60 + $110.69 + $13.80 = $269.09 Monthly cost

 

As you can see with Medicare a Supplement and RX plan an individual can budget their expenses and knows how much they will spend on health care even in a bad health year.  However even in a good health year they are spending the same amount.  One added advantage of a Medicare Supplement is no network, you can go to any doctor or hospital that accepts Medicare and the plan travels with you.  Example, if in Florida for 3 months, with a Medicare Supplement you can schedule an appointment or have a procedure in hospital while your there.

Option 2: Medicare Part B and adding a Medicare Advantage Plan with RX can start at $0.00 and end up going anywhere to 6,844.60 depending on the plans maximum out of pocket for the year.  It all depends on your health during that year.  92% of people on Medicare Advantage plans do not hit the maximum out of pocket.  A lot of hospital stay or chemo treatment for cancer are two ways that our quickest to hitting it..  They are a pay as you go plan and have HMO networks.  Some plans have PPO where you can go out of network and pay more.  Plans come with extras like Dental, Vision and Hearing.

$144.60 + $0 = $144.60 - ? Monthly cost  (? - depending on co-pays etc.)

As you can see above you can save a lot of money or not depending on your health situation for the year.  

Comparing the numbers above to your current health plan and situation can help determine if you should stay or go from your current health care plan.  

For more help please contact us at 216-659-7230 or by e-mail at dave@evergreenrs.net.

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