Retiree Health Insurance of Choice for Healthcare workers. "Straight Medicare".

***Image Source from Time.com***

Are you retiring from years of service from your health care job / career? Congrats on your soon to be retirement. May you enjoy your 'Golden Years'. Thank you for your service especially during COVID.

Are you turning 65 years young or older?

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Many former healthcare workers choose Original Medicare(Part A&B) as their primary retiree health insurance of choice. Designed to cover and pay up to 80% of medically necessary services and supplies. Healthcare workers affectionately refer to this fee-for-service-program as "Straight Medicare". Especially if you are working with medical claims that require coding or billing to CMS. You will want to read to the end to find out how to get FREE help with this sometimes confusing topic of Medicare enrollment and picking your retiree health insurance option.

Millions of healthcare workers have had experience with Medicare from the provider side such as doctors, nurses, specialists, OT's, PT's and the rest. It is estimated that 94% of the U.S. Healthcare System accepts assignment from Medicare. Whether providers are participating or non-participating, all are able to electronically file a claim and bill the Centers for Medicare and Medicaid(CMS) to be paid for their medical services to beneficiaries. This is an important distinction for healthcare retirees choosing Original Medicare overwhelmingly as their primary health insurance because many healthcare retirees know how medical bills are reviewed and paid from "Straight Medicare". It isn't always the highest payer to specific healthcare providers like for chiropractic services but CMS does offer the largest and most extensive single payer Fee-For-Service-Program in the U.S. for healthcare insurance coverage known at Original Medicare. 

Are there alternatives to Original Medicare?

Yes. Medicare Advantage(Part C) is the optional alternative to Original Medicare. Since network health plans like HMO's & PPO's are more affordable due to Medicare paying the health insurance companies to take on the risk of beneficiaries' health care costs, it has been a viable option for retirees who cannot afford Original Medicare plus a Medicare Supplemental Insurance Plan known as Medigap. However, some of the restrictions are concerning to many seniors on Medicare. More on top concerns for seniors below on the 2 main ways to get your retiree health insurance.
Another possible option is sometimes known as "Retiree Insurance". These health insurance coverages and programs are specific to state, federal or union employees based upon years of service. Many retirees should analyze their Retiree Insurance vs the Marketplace Medicare Insurance options. I posted about Retiree Insurance for the State of South Carolina Retirees here.  Posted about a doctor and his wife who were new to Medicare but found out they would be overpaying $1000+ per month in this post here. Many former healthcare workers like nurses, physicians, PT's, OT's & other healthcare workers have overwhelming choosen "Straight Medicare" benefits with Supplemental Insurance coverage for many years now.

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What are the TOP concerns from Americans on Original Medicare vs Medicare Advantage?

When polled retired Americans who are on Medicare shared their top concerns between Original Medicare tied with a Medicare Supplement(Medigap) Plan vs Medicare Advantage below. Since Original Medicare has gaps in coverage, Medigap Plans are standardized and designed to cover and pay for things like co-pays, coinsurance and deductibles to offer beneficiaries comprehensive coverage no matter which insurance company offers these type of supplemental plans. They must pay out by law after Original Medicare Part A & B pay their share. This is why Medicare Supplements Plan F, G and N are so popular as comprehensive coverage as the secondary to "Straight Medicare". Medicare Supplements vs Medicare Advantage top senior concerns chart below reflects the 2 main options seniors choose for their retiree health insurance.

As you can see, some of the main concerns from retirees and seniors are the max out-of-pocket risks and restrictions from Medicare Advantage plans. Most retired healthcare workers like the fact they have the freedom of choice with less restrictions on Medicare Supplement Plans. Medicare Advantage Plans are offered by private health insurance companies just like Medicare Supplement plans ***This is where a lot of confusion about Medicare comes from due to the same Brands offering both types of insurance options***. However, Medicare Advantage Health Insurance Plans are allowed to pre-certify treatments and use 'Prior-Authorization' as a tool to manage your health care cost because they become your primary health insurance. Although Original Medicare and a Medicare Supplement are comprehensive and offer nationwide coverage it comes with a higher monthly cost for beneficiaries. The monthly cost for an individual Medicare Supplement also known as Medigap plans varies widely in price and depends on the market or state. Medicare.gov only gives a list and range of pricing for Medigap Plans in your zip code. MedicareSavings.US does specific quotes and enrollment into your state for the most popular Medigap Plans. The most popular Medicare Supplement Plans are are Plan F*, Plan G & Plan N nationwide. Since these plans are standardized it is important to have an independent Medicare Supplement insurance broker help to shop for market value rates throughout your Medicare journey. Consumer-facing websites and captive insurance agents with only 1 brand often overcharge beneficiaries on these Medigap Plans. Be a smart consumer and get FREE help looking up quotes in your area. Don't be pressured into making a decision because there are many companies wanting your business that offer market value rates in your state. It is important that you know the heart of the agent or broker helping you while on your Medicare journey. There are so many seniors that are pressure into health plans that they don't quite understand because they were mis-informed or pressured into a restrictive network option that does not include their primary care physician or physicians group within the health plan.

Which option do most Americans and retirees choose?

Nearly 2/3's of the 60 million plus beneficiaries choose Original Medicare as their primary health insurance. Original Medicare is accepted by millions of healthcare doctors, providers and medical suppliers nationwide. Although Medicare offers 2 main ways to get health insurance, Original Medicare dominates the marketplace for retiree health insurance in terms of sheer size and scope of coverage than any individual or group retiree health insurance plan. Medicare Advantage Plans have over 3700 variations in network size and coverage due to much smaller networks that service beneficiaries locally, within a particular region or specific eligible group. Checkout the public data CMS shows below to get a better picture of Medicare as a whole. 

***Image Source from CMS.gov***

The Centers for Medicare and Medicaid(CMS), the governing body for Medicare & Medicaid, which many healthcare workers interact with throughout their career.  CMS shows a lot of important healthcare related data to providers, companies and the public.
Above is the 2018 Medicare landscape. Note that 64% of beneficiaries chose Original Medicare(Fee-For-Service Program affectionately known at "Straight Medicare" from healthcare workers). Below is a sample of new Medicare enrollees choosing Medicare Supplment(Medigap) plans in 2014. As expected, Florida continues to be the unofficial Medicare beneficiary capital of the U.S. with over 730,177 new enrollees into Original Medicare with a Medigap Plan(Nationwide Secondary Supplemental Insurance Policy) in 2014. There are more beneficiaries per capita in the state of Florida than any other state and this trend continues today. But the Southeast coastline states like Georgia, South Carolina and North Carolina are seeing a major influx of retirees in recent years.

CMS does show that Medicare Advantage plans have increase in enrollment in recent years. Especially in densely populated cities which has a strong local healthcare system of doctors and hospitals. Where Medicare Advantage does not do well in are the rural or less populated areas of each state. In the past Medicare Advantage Plans have been known to discontinue or terminate a health plan due to insolvency. Remember these Medicare Advantage companies rely heavily on new enrollees so the government can pay handsomely for each beneficiary enrolled.

Now that you have seen some of the concerns of retirees on their Medicare insurance options and data from CMS, what resources are available for healthcare retirees to GET HELP with their Medicare path of choice? You may not be surprised to learn that Medicare is not as 'straight' forward to enroll and choose your insurance option as you may think. Always consult your employer's benefits coordinator especially, if you have retiree insurance option that are tied to your years of service from your State or Federal employer. If you are having to choose your own marketplace Medicare insurance option then follow these 7 points below to get help from the Medicare community for your Medicare enrollment and/or to shop and purchase your insurance option. Get FREE Medicare Help below.

1. Beneficiaries must apply to enroll into Medicare Part A & B through Social Security Administration whether they pick Original Medicare or Medicare Advantage. Call SSA 1-800-772-1213 or Go to SSA.gov/benefits/medicare
2. Medicare.gov and MyMedicare.gov are official U.S. govt online resources for beneficiaries who chose Original Medicare as their primary. Plus you get 24/7 365 days Medicare Hotline Support at 1-800-MEDICARE(633-4227). Pro tip: Have your info ready and say "Agent" 2 or 3 times to speak with a live Medicare Agent during the initial tele-prompts.
3. Medicare.gov does NOT offer Medicare Supplement(Medigap) Insurance enrollment on their website.
4. MedicareSavings.US offers Medicare Supplement Insurance Options Nationwide.(Non-government retiree resource) for individuals, retiree groups & U.S. Employers with retirees that are Medicare-Eligible. They also have a trusted affiliate for all 50 states for Medicare Advantage Plans. Call 1-888-608-0654 to make an over-the-phone appointment.
   
5. Medicare.gov does offer individual Medicare Advantage Plan enrollment into HMO and PPO health plans with drug coverage nationwide. Click on "Find Plans" button. Remember, you are choosing for Medicare to pay the insurance companies to manage your health care costs throughout your Medicare Journey as the optional alternative. ***Look at Seniors Top Concerns Chart Above***
6. Medicare is the official administrator for Part D drug plans nationwide. Medicare tracks Part D enrollment and spending for all beneficiaries. So most folks enroll and shop their stand alone Part D(Pharmacy card) drug coverage yearly on their MyMedicare.gov account. This is for folks who have Original Medicare as their primary but want drug coverage as well.**Be aware of the possible penalties for not enrolling into a Part D drug plan outside of your enrollment period**
   
7. Why navigate Medicare alone? Get Help from a trusted friend, family or Medicare Insurance Broker. Medicare Savings out of Charleston, South Carolina is a FREE nationwide service to help beneficiaries enroll into their Original Medicare benefits along with making it easy to enroll into your Medicare Supplement Insurance Plan of their choice. We help to manage your Medicare Savings when possible. Don't be hassled. Make Medicare enrollment & insurance shopping easy with an independent brokerage. Call to make an appointment to get your Medicare help.

Lastly, some common factors retirees use to choose their Medicare path are based upon access to their providers, financial means, current and future medical expenses. 63% of retirees' top concern is paying for their future medical bills. As well as their tolerance for max out-of-pocket risks and expenses.

Medicare Enrollment can be burdensome without the right help. If you are a soon to be retiree, healthcare workers can choose a Medicare Supplement(Medigap) Plan up to 6-months prior to their 65th birth month or their Medicare Part B effective date if you are choosing Original Medicare a.k.a. "Straight Medicare". It is advised to get your Medicare information 6 to 5 months prior to you losing your employer based group health insurance. 

• Medicare Supplement Enrollment is the easiest part of your transition to Medicare.  Many retirees enroll 6-4 months in advance to ensure cross-claims with Medicare is setup and ready. Call Medicare Savings 1-888-608-0654 to make an appointment.
• Medicare Part A and Part B Enrollment through Social Security Administration should be done 3 to 1 month prior to Medicare Part B effective date. Enrolling into your Part B during or after your 65th birth month can cause a delay in your Part B start date. Avoid this by enrolling early. 
• Medicare Part D(Drug Coverage) Enrollment can easily be done on your MyMedicare.gov account or thru 1-800-MEDICARE(633-4227) 3 to 1 month prior to Medicare Part B effective date. **MedicareSavings.US does a FREE Part D analysis for policyholders that have a Medicare Supplement as a free benefit to client members**.  NOTE: Some beneficiaries may have sticker shock because their tier 3, 4 or 5 expensive Rx medication may have been covered by their group health insurance plan from their former employer. Always compare the retail(cash) cost vs Medicare Part D plans. There maybe some manufacturer or Part D Help programs available in your state to help for Rx costs. Call 1-800-MEDICARE for Part D Plan(PDP) help 24/7 365 days out of the year.

Article by 
Michael C. Fischbach
Owner/Operator of Medicare Savings

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I've spoken to numerous healthcare worker retirees. Many healthcare retirees continue to choose Original Medicare plus a supplement for their Medicare Insurance option of choice. Some healthcare retirees are eligible for state or federal retiree group health insurance due to years of service. The decision is always yours to make because you have the right to choose your Medicare insurance path. Be a smart consumer and know the pros and cons of your Medicare insurance paths for your retiree health insurance in your State.