65 and Working? 5 Steps to Prepare for Medicare

Is there a birthday more stressful than 65? Today people are healthier than ever at 65 and are living longer, which introduces new pressures for those about to turn that magic number.   Many people choose to put off retirement because of unforeseen financial burdens. The Sandwich Generation, as Baby Boomers are now being referred to, often have financial obligations not only to themselves, but to their parents, children and grandchildren.  Many have no choice but to continue working. Others are not ready for retirement from a physical and social aspect. A complaint often heard from those who have just retired is that of boredom. After working for 45 years and developing habits, it’s difficult to change gears. No matter the situation,  if you are 65 and still working, here are the 5 steps to prepare for Medicare:

1)  Talk with your employer about your health benefits

Most employers offer health insurance plans to their employees.  These plans are extremely affordable for older employees compared to individual plans.  Not only is the employer contributing to the premium, but most health insurance plans are based on the average age of the employees in the group.  If the average age in the health insurance plan is 37, then a 64 year old and 23 year old are paying the same exact rate for insurance based on the average age of 37. Those who are self-employed know that is not the case with individual health insurance plans.  Individual plans are based on your exact age and health condition, and can be prohibitively expensive at age 64. An employee usually has the option of staying on an employer health plan after turning 65, but is it the right decision?  It all depends on need and price.  Gathering the plan benefits and cost from the person who handles the health insurance benefits is the first step before making a decision. Timeframe:  5 months prior to turning 65

2) Meet with a Medicare Advisor

Medicare can be confusing.  There are many sources online that will explain Medicare options for those turning 65, but that should only be a starting point.  Make an appointment with a local Senior agency or a Medicare Insurance agent.  Plans and premiums vary depending where you live. A local representative will not only explain options and plans available in the county and state you live, but also have insight on trends in the industry and local providers to help you make the best decision for your needs. When meeting with a local Medicare advisor, the goal is to gather information regarding your options to supplement Medicare.  Most people choose to supplement Medicare to receive prescription drug benefits (Part D or Medicare Advantage) or lower their exposure to high-dollar medical procedures.  A Medicare Advantage plan or a Supplement Plan coupled with a Part D prescription drug plan will often provide better benefits at a lower cost than an employer health insurance plan. Once the Medicare Insurance options are compared to your current employer health plan, make an appointment with your primary care doctor. Time frame: 4 months prior to 65

3)  Visit your doctor for a check up

A physical prior to making changes to your health care is always a good idea.  While you are there, find out which Medicare insurance plans the office accepts.  Medicare Advantage plans primarily have networks which you must stay in.  It is important to verify the office accepts any plan you’re interested in. It is also important to get an alternate prescription list.  Your doctor may have prescribed a certain brand of generic high blood pressure medication based on the formulary of your current health plan.  A new plan you are considering may have a different brand of generic high blood pressure medication on their formulary, but can be just as effective.  When looking at the formulary of a new plan, it is important to know your drug needs are covered.  Even if it is a generic drug with a different name you’re used to seeing. Time frame: 4 months before turning 65

4)  Visit your local Social Security office

If you decide to drop your employer plan in favor of a Medicare plan, you must enroll in Part B in order to have access to most Medicare Advantage and Medicare Supplement plans.  Enrolling in Medicare Part B prior to the month of your Medicare eligibility will ensure your eligibility into other Medicare insurance plans.  Enrolling after your eligibility month will delay your Part B, and hence your insurance options.  For most people turning 65 in 2011, the Part B premium is $115.40 a month.  This could vary based on income and ability to pay. If you decide to stay on your employer health insurance plan, contact your local social security office to learn your options about delaying Medicare Part B.  If you have credible coverage, you can delay your Part B without having to pay the $115.40 a month premium.  But this is only true if you are on the employer plan and are still currently working.  The rules change if you retire and decide to stay on your employer plan. Time frame:  3 months before turning 65

5)  Make an appointment with a local Medicare Colorado Insurance Agent to enroll

If you made the decision to enroll in a Medicare Insurance plan, then the last step is to contact a local insurance agent to enroll.  It is important to enroll through a trusted, local Medicare insurance agent instead of going direct to the insurance company. Have you ever had to dispute a claim with an insurance company?  It’s not fun.  Any plan you enroll in will have the element of human error.  Whether the error occurs with the doctor, insurance company, pharmacy, or Medicare — errors will occur.  A local agent can help fix those errors, as the agent can better understand the problem and speak to the necessary people in the proper context to fix it. A local agent can also give guidance when needed, as the agent understands how the plan works in real-life situations within the community.  A two-minute phone call to a local agent is often preferred to being placed on hold with multiple voice-prompts and transfers before you may, or may not, get the answer you need from the insurance company. An agent will receive a commission from the insurance company upon enrolling you in a plan.  In most cases, the agent will continue to receive a commission for a set-time if you stay on the plan.  Therefore, there is a financial reward to keeping clients happy.  A local agent stays engaged with the changes to Medicare laws and plan options, as well.  As plans and premiums change, the agents adapt and will keep you up to speed with changes and provide support as needed. Time frame:  2 months before turning 65

What happens next?

If you enroll in Medicare Part B prior to your eligibility month, usually the month of your 65th birthday, then your Medicare Part A and Part B coverage will begin on the first day of your eligibility month.  If you enroll in a Medicare insurance plan during your initial coverage enrollment period, prior to the first day of your eligibility month, then your insurance coverage will also start on the first day of the month.  This is why it is important to enroll in a plan prior to your eligibility month. For more information on Medicare, keep visiting us at Medicare Colorado or follow us on Twitter.  And please help spread the word by retweeting this post or emailing it to a friend!