For Active Employees Moving from a Group Plan to Medicare:
Part 1 of a 3-Part Series

[row]
[column size=”col-8″]

Many Americans, age 65 and over, choose to keep working. These employees must decide whether or not to keep your group plan coverage. If they’re considering dropping that coverage and moving to Medicare, here are some of the things they may ask about.

Remember, everyone’s situation is different, and you don’t need to give employees advice. We’ve included resources at the end of this article that you can share with your staff. Also, note that we’re reaching out directly to members who will soon be Medicare eligible. The emails and letters explain new health insurance options available to them and how they may be able to save money.

How do I sign up for Medicare?
If you’re collecting Social Security, enrollment in Medicare (Parts A & B) is automatic at age 65. If you’re not yet collecting Social Security, you’ll need to sign up through the Social Security Administration. You can do that online at SocialSecurity.gov or by calling (800) 772-1213 / TTY (800) 325-0778.

What is the premium for Original Medicare?
For most people, there is no premium for Part A (hospital coverage). The standard premium for Part B (medical coverage) is $135.50 monthly. Note that this is the cost for 2019, and may change for 2020. Also, higher-income consumers may pay a higher premium.

How does prescription drug coverage work? 
Medicare Part D is prescription drug coverage purchased from private companies that are approved and under contract with Medicare. If you decide not to enroll in a drug plan when you first become eligible, you may pay a penalty if you choose to join later.

What are the out-of-pocket costs for medical care and prescriptions?
For Original Medicare, you’ll have the following basic costs in 2019 (amounts may change in 2020):

  • $185 yearly Part B deductible.
  • 20% coinsurance for most services, including doctor office visits, outpatient surgery, and urgent/emergency care.
  • $1,364 deductible for each hospital stay of 1-60 days. For hospital stays over 60 days, additional coinsurance would apply.
  • The Part D monthly premium varies by plan (higher-income consumers may pay more).


Are dental and vision covered with Medicare?
Medicare Part B does not cover most dental or vision care. You’ll need to shop for other plans that provide this coverage.

Should I get a Medicare Advantage or Supplement plan?
Only you can decide that, but consider that Original Medicare does have limits, and without your group plan as secondary coverage, you’ll likely want one of these options for additional coverage. Talk with PacificSource or an insurance broker for assistance in finding the right coverage for you.

Resources

Employees are welcome to contact us directly. One of our Medicare experts can consult with them about their unique situation: (855) 265-5969 or TTY (800) 735-2900.

Information on PacificSource Medicare Advantage plans:
Pacificsourcemembersfirst.com/medicare-age-in

Basic information on Medicare:
Medicare.pacificsource.com/Find/UnderstandingMedicare

The official U.S. Government site for Medicare:
Medicare.gov

[separator type=”default”]

You can read the rest of our series here:

Part 2 – How Group Coverage and Medicare Coordinate
Part 3 – For Medicare-eligible Employees Who Are Retiring

[separator type=”default-double”]

[thrive_leads id=’324′]

PacificSource Community Health Plans is an HMO/PPO plan with a Medicare contract. Enrollment in PacificSource Medicare depends on contract renewal. For accommodation of persons with special needs at sales meetings call (888) 863-3637 or TTY (800) 735-2900.

[/column]

[column size=”col-4″]

[content_box type=”without-header” text_color=”dark” color=”default”]

About this series

Every day, 10,000 Baby Boomers turn 65. That’s right—10,000 per day. That started in 2011 and will continue through 2030, according to the Pew Research Center. As they approach Medicare eligibility, these folks will need to navigate complex information and make important decisions about their healthcare coverage. To help you assist them, we’ve pulled together some basic info and resources into a three-part blog.

The first post in our series focuses on options for employees who would like to keep working, but move off group coverage and have Medicare only. Part 2 looks at considerations for active employees who opt to remain on your plan. And finally, part 3 addresses ways to assist employees who are planning to retire.

[/content_box]

[/column]

[/row]