Planning for the Medicare Annual Enrollment Period Starts Now
For the clients, the curtain opens Oct. 15. For their advisors, it's already showtime.
As the Medicare annual enrollment period approaches, advisors, insurance agents and employers must carefully consider the needs of Medicare-eligible people who are still working and who still have access to employer-sponsored health benefits aimed at active workers.
This group has unique health care needs and may benefit from resources and guidance on choosing between employer-provided benefits and Medicare options.
What should you consider when planning for open enrollment for Medicare-eligible workers?
The Medicare program’s annual enrollment period for Medicare Advantage plans and Medicare supplement insurance policies runs from Oct. 15 through Dec. 7. It’s separate from the initial enrollment period that occurs around the time people turn 65.
While workers with group health coverage generally are not required to enroll in Medicare when they turn 65, a special enrollment period allows an actively working employee to enroll in Medicare Part B outpatient services and physician services coverage at any time.
Employers and financial professionals should consider providing resources Medicare-eligible workers can use to navigate their health care options.
Here are some aspects to consider:
Basic Alternatives For Medicare-Eligible Workers
You and your employer clients should ensure that Medicare-eligible workers are well-informed about their health care options, which typically include:
Employer group health plans: As their original form of coverage, many employees may choose to stay with their employer-provided health insurance.
Medicare plans: Any Medicare-eligible employee’s options include Original Medicare, Medicare Advantage Plans, Medigap Supplemental Plans, and Part D Prescription Drug Plans.
Providing Resources and Guidance
You and your employer clients can assist Medicare-eligible workers by offering resources to help them understand Medicare and make informed decisions.
Here are ideas about what you and employer clients can provide:
Educational workshops and seminars: Host sessions to explain Medicare basics, enrollment periods, and how to compare Medicare with employer-sponsored plans.
Consultation services: Provide one-on-one consultations for employees.
Online resources: Create a dedicated section on your website or employer clients’ intranets with articles, FAQs, and links to official Medicare resources.
Advantages of Medicare Plans
For some clients, and some of employer clients’ employees, Medicare may offer advantages over employer-sponsored health plans, such as:
Broader networks: Beneficiaries who use Original Medicare together with Medicare supplement insurance can see any doctor who accepts Medicare, providing more flexibility in choosing health care providers.
Stable and affordable premiums: Many Medicare Advantage plans offer $0 premium options and low-cost Part D prescription drug plans.
Lower deductibles: Workers who use either Medicare Advantage plans or Medigap policies often have lower deductibles or even $0 medical deductibles.
Reduced out-of-pocket costs: Medigap policies can eliminate most out-of-pocket costs after meeting the Part B deductible, while Medicare Advantage plans often have low co-pays instead of coinsurance payment requirements.
Comparing Costs
In one example, Policy G, a popular Medigap plan, covers all out-of-pocket costs for Medicare-approved services once the Part B deductible is met.
Medicare Advantage plans, while potentially requiring network restrictions, offer low premiums and co-pays, making them an attractive option for many.
Jane, a 65-year-old administrative assistant, faced a critical decision during last year’s annual enrollment period. She had the option to stay on her employer’s health plan or switch to Medicare.
Jane talked to a Medicare specialist who explained her options in detail. After learning about the stable premiums and broader networks offered by Medigap plans, Jane decided to compare costs.
With the help of the Medicare specialist, Jane discovered that Medigap Policy G would cover most of her medical expenses after meeting the $240 Part B deductible.
This plan offered her the freedom to choose any doctor who accepts Medicare. Additionally, her monthly premium was lower than what she paid for her employer’s plan. Jane’s decision to switch to Medicare not only saved her money but also provided peace of mind with comprehensive coverage.
Medicare Considerations that May Favor Employer Plans
Despite the benefits of Medicare, some clients might find employer plans more suitable, particularly if:
Employer premiums are lower: If the cost of the employer plan is lower than the Medicare Part B premium ($174.70 in 2024), employees may prefer to stay with the employer plan.
Health savings accounts are in use: Employees with HSAs often stay on employer plans to continue to make tax-advantaged contributions and receive employer contributions.
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Credit: CMS