5 Questions to Ask When Comparing Medicare to Group Coverage

You’ve worked hard your whole life, and now you’re finally nearing retirement. But when considering Medicare and employer health insurance after 65, navigating your health insurance options can feel like another full-time job. Don’t worry, we’re here to help.

Many people approaching 65 wonder if they should stick with their employer’s group health insurance or switch to Medicare. There’s no one-size-fits-all answer, so it’s essential to ask the right questions to make the best decision for you.

5 key questions to ask when comparing Medicare to your employer’s coverage

1. What are the total costs?

• Premiums: How much will you pay each month for your employer’s plan versus Medicare?
• Deductibles: What’s the magic number you need to hit before coverage really kicks in?
• Copays and Coinsurance: What will you pay for doctor visits, specialists, and those inevitable prescriptions?
• Maximum Out-of-Pocket: What’s the worst-case scenario for healthcare expenses in a year?

2. Does the insurance plan cover my unique health care needs?

• Pre-existing conditions: Are there any limitations or exclusions on either plan?
• Prescription drugs: Are your medications covered? (Don’t forget to check those formularies and cost tiers!)
• Specific treatments or specialists: Do you need regular treatment for a specific condition? Does one plan offer better coverage for that?
• Travel: Snowbirds and globetrotters, pay attention! Which plan offers better out-of-network or international coverage?

3. How does each plan coordinate with other coverage?

• Medicare and working over 65: Will your employer’s plan be the primary or secondary payer with Medicare? This can significantly impact your costs. Read more about Coordination of Benefits here.
• Other coverage: Do you have retiree benefits or a spouse’s plan? How will these work with Medicare and your employer’s plan?

4. What are the provider networks?

• Doctors and hospitals: Make sure your trusted doctors and preferred hospitals are in-network with both plans.
• Referrals: Does one plan require referrals to see specialists?

5. What are the extra benefits?

• Dental, vision, hearing: Does one plan offer better coverage for these often-overlooked essentials?
• Wellness programs, gym memberships: Are there any perks that could improve your overall health and well-being?

Need more help comparing Medicare vs. employer health insurance?

• Read the fine print: Carefully review the Summary of Benefits and Coverage (SBC) for both your employer’s plan and any Medicare plans you’re considering.
• Ask the experts: Contact your employer’s HR department and SmartMatch for personalized guidance. 

Don’t leave your health insurance to chance. By asking these key questions and doing your research, you can make an informed decision and enjoy your golden years with peace of mind.