Stay on wife's employer health insurance, or Medicare?

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Papajoe56
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Stay on wife's employer health insurance, or Medicare?

Post by Papajoe56 »

[thread title edited to remove all caps - moderator prudent]

I am on Social Security, and recently got my Medicare card in the mail.

My wife still works, and I am currently covered under her employer plan at a cost of $609/month which includes Medical/Drug coverage.

Dental/Vision is another $26.40/month.

I know I can opt out of Plan B ($148.50/month), and other Medicare plans as long as I stay on the employer plan.

I am faced with the decision to go on Medicare or say on spouses plan until she retires in 12 months.

I am sure others here have been in this situation.

If so, what did you decide to do, and what factors were key in making the decision?
RetiredNewbie
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by RetiredNewbie »

If you don't get Plan B now, you will face a 10% penalty on your monthly payment for every year you wait. I'd get it now. Medicare and your wife's health insurance plan should be able to coordinate benefits.
Your attitude about risk changes significantly when the bear begins to maul you.
Golfview
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by Golfview »

Don't forget you will still need a Medicap or Medicare advantage plan to pay for the 20% Medicare doesn't cover add that to the 144.50.
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Artful Dodger
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by Artful Dodger »

First, you need to confirm with your wife’s employer whether you need to sign up for Part B. If her employer has more than 20 employees, you usually do not have to sign up for Part B. There’s also no late enrollment penalty as long as your covered on your wife’s employer sponsored plan and she’s an active employee.

Also, it is normal for employee deductions for medical to be taken from payroll on a pre-tax basis. I don’t know your particular tax situation but assuming 7.65% FICA, 18% federal, and 5% state, that’s a 31% savings, so your $609 cost is really $420 after the tax savings. There are a few situations where the premiums are not pre-taxed, so confirm with her employer.

You also need to take into account your benefits from her plan. $100 deductible? $1000? 100% or 80% coverage? Copays? Out of pocket limit?

If you buy a traditional supplement in my area the cost is around $165 and it covers 100% of what Medicare doesn’t above the Part B deductible. You will have to purchase a Part D RX plan which can cost between $25 and $125. A Medicare Advantage plan will usually include the Part D benefit and cost quite a bit less than the supplement/ Part D combo, but likely have more copays/ coinsurance out of pocket cost.

Employer plan - $420

On your own (estimate)
Part B premium- $148
Supplement- $165
Part D - $75
Total - $388

If you’re in a metro area with several good Medicare Advantage plans, check out their networks and benefits. They could be a good choice and much less expensive than the supplement/ Part D combo. You’ll still pay the Medicare B premium but the Medicare Advantage premium will likely be less than $100 and as low as $0
mhalley
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by mhalley »

Medicare is going to be much cheaper. Any anticipated healthcare expenses this year? Rx drug costs? Difference in deductible? Looks like Medicare plus supplement plus rx drug plan will be cheaper.
Topic Author
Papajoe56
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by Papajoe56 »

RetiredNewbie wrote: Thu Apr 01, 2021 8:50 am If you don't get Plan B now, you will face a 10% penalty on your monthly payment for every year you wait. I'd get it now. Medicare and your wife's health insurance plan should be able to coordinate benefits.
My understanding is as long as I have employer coverage through wife's plan, I can add (other than part A) Medicare plans B,D,GAP,etc. when she comes off her employer plan w/o penalty.

This is called Special Enrollment Period,as explained in link below.

https://www.medicaremadeclear.com/enrol ... ent-period
123
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by 123 »

We have an aunt and uncle in similar situation. In their case the cost of Part B and a Medicare Advantage Plan was much less than the employer's premium for spousal coverage on health insurance. It all depends on whether you can be happy with a MediGap or Medicare Advantage Plan versus the spousal advantage plan. Sometimes you won't notice any difference, sometimes you will, it all depends on your usage of health care.
The closest helping hand is at the end of your own arm.
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Papajoe56
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by Papajoe56 »

mhalley wrote: Thu Apr 01, 2021 10:24 am Medicare is going to be much cheaper. Any anticipated healthcare expenses this year? Rx drug costs? Difference in deductible? Looks like Medicare plus supplement plus rx drug plan will be cheaper.
Thanks I will look at the numbers, and I have looked at a page on www.medicare.gov where one can enter current prescriptions and get costs for different insurance providers.

I find it strange that no page can be found online that allows one to enter current employer costs for hospital/medical as compared to Medicare GAP, Advantage, insurance costs.
runninginvestor
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by runninginvestor »

Papajoe56 wrote: Thu Apr 01, 2021 10:37 am
RetiredNewbie wrote: Thu Apr 01, 2021 8:50 am If you don't get Plan B now, you will face a 10% penalty on your monthly payment for every year you wait. I'd get it now. Medicare and your wife's health insurance plan should be able to coordinate benefits.
My understanding is as long as I have employer coverage through wife's plan, I can add (other than part A) Medicare plans B,D,GAP,etc. when she comes off her employer plan w/o penalty.

This is called Special Enrollment Period,as explained in link below.

https://www.medicaremadeclear.com/enrol ... ent-period
Papajooe, you are right. You may be allowed to delay Part B enrollment if yoiui qualify. I'd just double check your group plan to have sure it qualifies.
https://www.medicare.gov/sign-up-change ... -parts-a-b

Additionally, you'll need the employer to fill the SEP form for employment verification when the time comes to enroll in part B (if you delay):
https://www.cms.gov/Medicare/CMS-Forms/ ... /CMS009718

As far as delaying vs not, you can call some brokers (go to your state SHIP website) to cost out some supplement plans. You can also compare costs at Medicare.gov. That could help determine the cost/benefit now. Although 12 months from now rates and available plans will likely change in 2022, especially if you go with a supplement (advantage plan or otherwise).
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Papajoe56
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Re: STAY ON WIFE'S EMPLOYER HEALTH INSURANCE OR MEDICARE

Post by Papajoe56 »

123 wrote: Thu Apr 01, 2021 10:46 am We have an aunt and uncle in similar situation. In their case the cost of Part B and a Medicare Advantage Plan was much less than the employer's premium for spousal coverage on health insurance. It all depends on whether you can be happy with a MediGap or Medicare Advantage Plan versus the spousal advantage plan. Sometimes you won't notice any difference, sometimes you will, it all depends on your usage of health care.
Thanks.

If that is the case, I probably should just get off wife's plan.

We currently have United Health Care via Insperity Holdings for coverage, and we despise UHC.

She is now recovering from major surgery.

UHC's response for authorizations for treatment were very slow, and may have complicated the severity of her illness.

We will not be choosing them as out Medicare insurance provider.
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Watty
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Re: Stay on wife's employer health insurance, or Medicare?

Post by Watty »

Papajoe56 wrote: Thu Apr 01, 2021 8:41 am If so, what did you decide to do, and what factors were key in making the decision?
Be sure to check to see if you are actually allowed to stay on her plan once you qualify for Medicare.

My recollection is a bit fuzzy but as I recall when my wife qualified for Medicare she was required to switch to that, but we were using COBRA then so the rules may have been a bit different.

I found the book Medicare for Dummies to be very good(despite the title) when we were first getting on Medicare and other people have also posted about finding that book useful. If you get is be sure to get the most recent edition since a new edition came out last fall.
musicmom
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Re: Stay on wife's employer health insurance, or Medicare?

Post by musicmom »

Maybe employers cover this differently?

My husband has always been covered as a dependent on my megacorp employee plan.
When he turned 65, he was able to defer part B with no penalty and continued with my insurance primary.

When I retired at 62, he was then required to start part B (no late penalty) and my retiree plan became his secondary.
Im still on retiree only. Will sign up for Medicare this October. Retiree plan will then be my secondary as well.

Retiree plan costs <$200 month for us both, includes great drug coverage but no dental.

Is it supposed to be this complicated?
Topic Author
Papajoe56
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Re: Stay on wife's employer health insurance, or Medicare?

Post by Papajoe56 »

Watty wrote: Thu Apr 01, 2021 11:05 am
Papajoe56 wrote: Thu Apr 01, 2021 8:41 am If so, what did you decide to do, and what factors were key in making the decision?
Be sure to check to see if you are actually allowed to stay on her plan once you qualify for Medicare.

My recollection is a bit fuzzy but as I recall when my wife qualified for Medicare she was required to switch to that, but we were using COBRA then so the rules may have been a bit different.

I found the book Medicare for Dummies to be very good(despite the title) when we were first getting on Medicare and other people have also posted about finding that book useful. If you get is be sure to get the most recent edition since a new edition came out last fall.
Some employer plans may also require a Medicare eligible person to go on Medicare.

Yes there are different rules for COBRA.

They probably do not consider one using COBRA actually in/on an employer's plan anymore.

COBRA is very expensive based on my experience.

A company I previously worked for was sold, then downsized by a new owner, and some employees were shocked at COBRA coverage costs.

I will buy Medicare for Dummies.
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Papajoe56
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Re: Stay on wife's employer health insurance, or Medicare?

Post by Papajoe56 »

musicmom wrote: Thu Apr 01, 2021 11:10 am
Is it supposed to be this complicated?
It should not be.

Obviously the govt. knows it's complicated, or they would not have SHIP programs.

I can think of nothing being simple when dealing with a govt. entity.
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Eagle33
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Re: Stay on wife's employer health insurance, or Medicare?

Post by Eagle33 »

Since you don't like your wife's insurance, I recommend you switch to Medicare Parts B & D plus a Medigap plan now. The Medicare system/rules are setup for claiming Medicare when you turn 65. The system does allow exceptions, but there are hoops to jump thru and landmines to avoid - especially if you live in a state that does not allow changing between Medigap plans without underwriting.
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