Health Insurance and the Game of Life

I recently completed a 17-hour “Intensive Medicare” continuing education course that I felt would be useful, as we have many clients that are, or are nearing, retirement age. You might imagine that Medicare rules must be very complex for them to come up with 17 hours of material on it. It reminds me of when I was a child, I would play games with my grandfather, where I essentially made up the rules as we went along. Isn’t it funny that I would always “win” these games? You can set yourself up to win in the coming year if you start thinking about health insurance coverage as open enrollment rolls around.

What are some things to keep in mind for Medicare?

1. Check your mail: You may get important notices from Medicare or Social Security. If you’re in a Medicare plan, you’ll get an Annual Notice of Changes. Note any changes to your health coverage or any Extra Help you may get to pay for prescription drugs. You may also get health plan marketing materials from insurance companies that offer Medigap and prescription drug plans. Remember that plans aren’t allowed to call or come to your home unsolicited, and you should never give your information to anyone you are not familiar with.
2. Review your 2025 Medicare and You handbook: You may receive it in the mail, or you can access it online.It has information about Medicare coverage and Medicare plans in your area.
3. Think about your needs for next year: Carefully review your Medicare coverage materials during Medicare Open Enrollment (mid-October through early December). Did you know that most individuals stick with their original choices for Medicare coverage even though they could save money and have better coverage with a different plan? You should note any changes in costs or benefits for your existing plan each year. Decide if your current coverage will meet all your needs for the year ahead and if it is the most cost effective. If you like your current coverage and it’s still available for 2025, you don’t need to take any action.
4. Preview 2025 health and prescription drug plans: Medicare Plan Finder makes it easy to compare coverage options and shop for health plans. Log in or create an account to compile or access a list of your drugs, compare your current Medicare plan to others, and see prices based on any help you get with drug costs. Most notably in Part D, Prescription Drug coverage, it is wise to re-evaluate your individual situation and ensure that the prescriptions you rely on are being covered by the chosen plan. It is very common for prescription plans to alter the coverage levels for particular drugs, as well as to add/delete coverage entirely for some drugs. Additionally, your own health situation may have changed, affecting the list of prescription drugs you are currently taking.
5. Plan for what may not be included: Know that Dental and Vision usually need to be addressed separately or supplemented, as coverage under Medicare is at least limited. Medigap plans may be the solution to cover some of these additional costs.
6. Get personalized help in your community: If evaluating the available choices is overwhelming, contact a volunteer Seniorsʼ Health Insurance Information Program (SHIIP) counselor through your local senior center to set up an appointment to discuss your options. 
7. If your health care needs are more complex, you can also search for a Certified Medicare Insurance Planner (CMIP)  in your state: These advisors can help you make the decision as to the best coverage for the year ahead.

65 and still covered by employee coverage?

If you or your spouse are still employed by a company with more than 20 employees, you may be able to delay Medicare enrollment and avoid paying the premiums until coverage through the employer is lost. Note that COBRA and retiree medical are not considered “employee” coverage for the purpose of delaying Medicare. If you’re unsure about whether you need to enroll in Medicare, you can ask your employer or insurance provider to confirm.

Fall is typically the time your employer opens benefit enrollment for the following year. The dates of the enrollment period are specific to the employer, so be aware of the timing for your company. This is a significant perk of employment and represents part of your overall compensation package, so it’s worth your time to review carefully on an annual basis.

One of the biggest choices you have during the benefits enrollment period is to select your medical/dental/vision coverage for the upcoming year. This is an important choice for your entire family to ensure you are adequately covered in 2025. Additionally, you are making important choices about other employer benefits, such as disability coverage levels, life insurance, Health Savings Account deferrals, Flex Spending Accounts, etc. These tend to garner less attention during the selection process but can offer critical protections for your family and should be evaluated annually.

If you are working with a financial advisor, send them a copy of the choices available to help shore up personal life or disability policies, and to ensure you are taking full advantage of the benefits available to you as an employee. For most of these choices, your employer enrollment benefit period is the only time you can make changes to your levels.

Additional information can be found at https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65