[Podcast] Medicare: Comparing group insurance vs. Medicare options - Medicare Simplified

In this episode of Medicare Simplified, we focus on how you can sort through costs and coverage while working, before turning 65.





Mick Garry (host): Welcome to “Medicare Simplified,” a podcast by Sanford Health Plan. I'm your host, Mick Garry.

Many of you plan to keep working past the age of 65, which is when you become eligible for Medicare. It's critical to know your health care coverage options during this time. A side-by-side comparison of group health insurance and Medicare can help you reduce confusion and avoid mistakes that could cost you.

Helping us get to the bottom of this topic today is Jack Arnett, a manager at Sanford Health Plan. Jack, where do our listeners begin? What are some of the main differences they should know?

Jack Arnett (guest): My first words of advice to potential retirees or those planning to work beyond age 65 is to know that here at Sanford Health Plan we have an internal team of subject-matter experts as well as partners with more than 200 brokered professionals who are all willing to help navigate you through the decision-making process.

If anyone needs assistance, simply call myself or anybody at the Sanford Health Plan, and we will get you the help and the assistance that you need.

Now, for the second part of your question relative to main differences they should consider: Each individual could have some unique situations.

Some of the common denominators that we see all the time when comparing group health plan versus Medicare:

No. 1 is wondering whether leaving my group health plan, will it adversely affect any family members on my plan? Traditionally we’re seeing situations where one spouse is turning 65 and the other spouse is turning 63. What happens with the younger spouse if I leave that plan? That's a huge, huge component in considering group health plan versus Medicare.

No. 2, prescriptions are very common and there is nothing more important to retirees’ health than the prescriptions that they're taking. And so what are the deductibles, the co-pays and the cost shares on their group plan vs. Medicare? In my 25-plus years in this industry, I can say, especially on Tier 1 and Tier 2 (preferred generics and generics), there's not a great difference between group health insurance and Medicare Part D plans. But when you get into Tier 3, Tier 4 and Tier 5, I have seen some significant differences.

One of the key things when considering retiring and going on Medicare or maintaining that group health is to make sure you do a deep dive with your insurance professional relative to your prescriptions. Another thing that's a very common denominator is the network, which in this case refers to the hospitals, clinics and physicians that you have now under your group health plan and may have been with for decades. Are they also part of the Medicare plan I’m considering?

Also under a group plan, a lot of times they include benefits like dental, vision and hearing, which is very important. What would my Medicare plan cover? Traditional Medicare, Medicare A and B do not offer basic dental, vision and hearing coverage. However, there are Medicare Advantage plans like Sanford's and Align that do include benefits for these very important items.

These are just a few of the many questions retirees or potential retirees need to consider. There is no rush. That's my No. 1 piece of advice here. Take time. Get with a trusted source to do that side-by-side comparison. If you're considering retiring a year from now, that is not too early to start getting the answers and the guidance that you need to make that decision.

Mick Garry (host): Do you have an example of a couple who might be facing this health care decision?

Jack Arnett (guest): Yes, I absolutely do. I helped a couple up in Bemidji, Minnesota, just this last fall in this exact type of scenario where the wife was retiring from Sanford and wanted to consider all of her options. And her spouse was actually five years younger, so it wasn't just a few months that they'd have to consider, it was a five-year gap. And so we sat down and we did kind of a cost analysis.

We looked at what she is currently paying for her group insurance versus what it would be on Medicare and going on the Align Medicare Advantage Plan, powered by Sanford Health Plan. In a lot of cases going on Medicare came out on the positive side, but for her spouse at age 60 that was another story. We looked at some options for him for an individual plan.

Sanford Health Plan offers options for those in this situation. It took about two hours to do this comprehensive review. Then they thought about it for a few days, called me back, and ultimately it ended up that the retiring spouse – who was retiring at the end of 2022 – decided to enroll into Align and then we were able to connect her husband with one of our group health plans. It took awhile but these are not quick decisions to make. There are so many things to consider.

Most of it is financial: For instance, what happens in the scenario I mentioned with the husband and the cost that he would have to pay when the spouse is retiring and she has no desire to keep working five more years? The key here is to take the time. She contacted us a couple months prior to her retirement age. I highly encourage people to get in touch with us six, eight or 12 months in advance to get the information you need. Mick Garry (host): Are there common questions you get from people researching their options?

Jack Arnett (guest): There are, especially these days when we are a lot more mobile society. The questions can have to do with what's available in another state if they're looking at the Align Medicare Advantage powered by Sanford Health Plan. Will that cover me if I'm in Arizona or if I'm in Florida? Those are very common questions. Or even if they just travel a little bit or if they're full-fledged snowbirds like my mother-in-law is.

As I previously mentioned, a big thing is the network. Can I still see my doctor? Can I still go to the clinic that I want to see my specialist at my hospital? Do I still have options when I go onto Medicare in a Medicare Advantage plan? So, very common questions like that. But again, each person has, or each couple could have very unique situations.

Mick Garry (host): Now that we've spent some time comparing, what should people do next?

Jack Arnett (guest): Whether we’re talking about an individual, a married couple or significant others, first of all, talk amongst themselves. You know, what do we want to do? Where is our future? Where do we want to go? And then get with a licensed, trained, certified insurance professional who deals with Medicare Advantage plans like I do, or the people on my team or the 200-plus brokered agents. We go through certifications, trainings and licensure each and every year. You want to make sure you're dealing with somebody who has that has that level of experience.

You see a lot of commercials, you know, especially during Medicare's annual enrollment period pushing this or advocating for that. And I'm not disparaging that, but you want to get with somebody local, somebody who has been doing this, somebody who understands and someone who is going to be able to guide you through that decision-making process.

As I mentioned before, this is not a one-day decision. When you're considering retiring and leaving that group plan and possibly looking at Medicare, in a Medicare Advantage plan, you need a lot of guidance and support for a lot of decisions that need to be made. You don't need to do it alone. There are a tremendous amount of resources, and not just with Sanford Health Plan. Each state has individual senior health insurance programs.

There are a lot of great resources out there. So take your time, do your research, do your due diligence. That’s going to make you comfortable with the decision that you make.

Mick Garry (host): Thanks, Jack, for those useful examples regarding group insurance and Medicare. If you'd like to learn more about Medicare Advantage plan options from Sanford Health Plan, visit align.sanfordhealthplan.com or find more information in our episode show notes.


Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex, or any other classification protected under the law. This information is not a complete list of benefits. Call (888) 605-9277 ( TTY: 711) for more information.

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