This is my week to tell people they don’t need my services. I talked to three people who have the state Medicare retiree plan because they are retired teachers. They thought they were paying too much for their Medicare Advantage plan (about $100 per month), and they had issues with referrals that come with an HMO. I went through their evidence of coverage book and concluded that their plan is awesome, and I told them so.
The plan I was looking at is a Medicare Advantage plan, but it’s not like the ones I enroll people in. Here are just a few of the awesome benefits: Hospital co-pay: $100 (that’s it!); Part B drugs (like chemotherapy): 0% co-pay; Radiation therapy: 0% co-pay. Part D coverage: no donut hole!!
As an insurance agent I’m not supposed to mention benefits, but I am describing a plan I do not sell. And it is a plan that other insurance agents should not move people out of to put them into a $0 premium Medicare Advantage plan they sell.
Some people don’t need Medicare.
Yesterday I got a call from a man who turns 65 in November. He told me his wife is still working and her employer is a big company, which is a very important factor. This man has his Medicare card and will start paying his Part B premium next month. I told him to find out how much his wife is paying to have him on her insurance and to find out if the insurance is good coverage. But because her employer is a national, large company, the health insurance is probably pretty good – and he may not need his Medicare.
If a person is covered by employer health insurance after they turn 65, they don’t need to enroll in Medicare Part B and pay the premium. The company must have more than 20 employees. However, people who work for small-to-medium size companies (with over 20 employees) often have lousy and expensive health insurance, so they might be better off using their Medicare.
I told this potential customer to investigate his health insurance, how good it is, and how much it costs. I also told him he could use Medicare as secondary insurance to (possibly) cover deductibles and co-pays. But I had to admit I have not dealt with this, so I referred him to the Medicare.gov website. I told him he could also call 1-800-MEDICARE to learn more about how Medicare co-ordinates with other health insurance.