Medicare Matters: Navigating the Transition for Plan Members 65 and Older

By Bill Frack, Chief Product Officer

It’s open enrollment season. Maybe you’re wondering: Should my health plan members 65 or older enroll in Medicare?

In most cases, the answer is YES, it’s in their best interest!

How do you know whether Medicare is better for my employees than our company offering?

The offerings are generally not apples to apples – Medicare Advantage plans (Medicare managed care provided by carriers such as Humana, United, Aetna, and many others) are able to offer a wide range of additional services that employers may or may not provide. Examples include vision, dental, hearing, gym memberships, wellness, and community support. 

It boils down to the insurance value. Wellnecity uses a simplified comparison of what the member pays in premiums and what they receive in insurance value, maximum out-of-pocket (“MOOP”). We make sure to include the Part B premium in our calculation. If Medicare values are similar or better, then members should be evaluating their alternatives.

So why don’t members immediately take advantage of this opportunity?

Confusion. In addition to endless TV commercials, members receive innumerable offers via the mail, online, phone, etc. In face of this inundation, members often “stay put” because they default to the current, familiar solution.

How can we help our members discover this opportunity?

Provide a reliable source of clear information and a pathway to a consultation with a trustworthy Medicare agent who can help members compare your employer plan with all the available Medicare options, considering their particular care needs.

Are there restrictions on what an employer is allowed to do?

Yes, CMS (The Center for Medicare & Medicaid Services), which oversees the provision of Medicare and Medicaid, provides specific rules to prevent employers from inducing employees to move onto a government plan. For example, employers cannot induce migration with subsidies or give employees contact information to a broker.

However, this does not prevent an employer from helping their employees obtain information from a trusted source.

Unfortunately, many advisors use “compliance risk” to scare employers from providing their employees with useful information.

How do I know if my program is effective?

If you have an effective program, 20-25% of Medicare age members will choose to convert to Medicare plans each year (based on Wellnecity experience).

Unfortunately, there are many so-called awareness initiatives that fail to engage members – the underattended seminar being the poster child.

This open enrollment season, what steps are you taking to ensure your Medicare-eligible members are well informed?

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