Employee Group Plans vs. Medicare; When to Cut the Cord.

by Marc Manor

If you are coming up on age 65 and you are still working and are using an employee group health insurance plan you may be asking yourself if you should dump the employer plan to take advantage of your Medicare benefits.  If you thought that, you are not alone.  This situation comes up frequently and as an agent, I can only really answer by making a recommendation that you seek assistance from your company benefits advisor.

Seeking assistance from your benefits advisor is really the only answer because they should be the most knowledgeable about the group plan benefits.  Human Resource professionals earn their living managing employee benefit plans.  So, as you ask yourself the question of whether to part ways with your employee group plan to join Medicare, you need to go to HR.  You may be fortunate and get the HR professional that provides you with all the information you need to make an informed decision; or you may just be handed a form and be left on your own to make the decision.

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Either way, you need to know the questions to ask just in case you aren’t presented with enough information to make a determination best suited for your situation.  Here are some tips:



Finding out what Medicare has to offer - By becoming familiar with the Medicare options contained in various Medicare Advantage, Prescription Drug Plans, and Medicare Supplements, you can start drawing comparisons on what benefits affect you most and how those stack up beside your employee plan.  A trusted Independent Medicare Agent is a great resource to help explain your Medicare benefits under a variety of scenarios.  Most agents do not charge a fee for a consultation.

What about deductibles? - Most employer plans have deductibles for both medical services and prescription drugs.  Compare your employee plan against those offered by Medicare Plans.

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Co-pays and Co-insurance - Co-pays are set amounts and Co-insurance is a percentage of the bill that you will be responsible for in each situation.  Compare these to your employer plan while paying particular attention to the services you use the most.

Additional benefits and services - The competition in the Medicare Advantage market is fierce.  Many times, Medicare Advantage plans include dental, fitness club memberships, and other perks that may not be available in your employee plan.

Provider Networks - You may want to stay with your current provider and specialists.  If that’s important to you, verify the doctor networks under the Medicare insurance plans to make sure you can stay with your providers.  In some cases, you may find that the networks in the Medicare plans may be more robust depending on what is available in your community.  If you opt for Original Medicare, there are no networks, so you can use any provider that takes Medicare.  Just be aware that of the costs for any additional Medicare Supplement and Prescription Drug Plans that may be needed to cover Original Medicare Co-Insurance should be considered.  This is another area where an Independent Medicare Agent can objectively help you compare costs and highlight any other areas that may be of value.

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Once you make the decision to leave your employee health plan and opt for Medicare, there may be no turning back.  This is all the more reason for you to carefully look at all the options before making the decision on whether a change will benefit you.  Spending some time researching on the medicare.gov website and talking to an Independent Agent will be time well spent. 




Marc Manor is a 30-year military veteran who is now dedicated to teaching his 
fellow Americans how to make the most of their Medicare and Supplemental Insurance 
benefits. As an independent agent, Marc has access to a wide variety of carriers with 
an abundance of resources to find tailored solutions. There is no charge for a 
consultation so call 904-222-0698 or email: marc@marcmanor.com.