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Comparing Coverage: A Medicare Customer Q&A

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What You Need to Know

  • Many Americans are staying employed past age 65.
  • For them, Medicare and employer coverage may both be on the menu.
  • One common question is about how Medicare benefits compare with group health benefits.

After the events of this past year, many workers over 65 are examining healthcare coverage in light of rising costs and more awareness of the value of Medicare.

Every day in the United States, 10,000 adults turn 65. The pandemic forced over 1 million older Americans out of the workforce, but millions more are approaching retirement age and choosing to remain employed.

For those workers, the question of whether or not to switch from an employer plan to Medicare is highly relevant and a topic for serious contemplation. In response, here is a breakdown of the benefits of switching.

The Question

With open enrollment coming up in November, I’m thinking about switching coverage now that I’m over 65. Can Medicare provide me with better coverage than an employer plan?

The Answer

The short answer is that it depends. The most important factors that should go into this decision are your health care needs, so you’ll need to consider the many different options in plans, the focus on medications, and whether or not the doctors you see will be in-network, and comparing that to your current coverage. Let’s start by taking a look at what Medicare provides.

Medicare offers different options based on which part you enroll. Medicare Part A provides coverage for hospital expenses, such as inpatient stays, hospice care, some at-home health services, and stays in skilled nursing facilities. Part B covers other medical expenses, including doctors’ visits, various types of therapy, and part-time assistance from health aides or skilled nurses.

Medicare Part C, commonly referred to as “Medicare Advantage,” is a combination of Parts A and B. There are also Medigap plans that provide supplemental insurance coverage, but individuals cannot have both Medicare Advantage and Medigap. There’s also Medicare Part D which is available for prescription drug coverage.

For older Americans still on employer health care plans, if you work for a large employer, signing up for Part A and B is optional, although Medicare typically offers lower deductibles and lower premiums.

It is beneficial to look at what Medicare plans are available and compare them to your existing coverage, in order to see what Medicare has to offer and determine if a Medicare plan will save you money or offer better coverage than the employer plan.

Bethany CissellBethany Cissell is a health care insurance services specialist at Allsup.

(Image: Adobe Stock)