MEDICARE
By California Broker Magazine
If you have clients who are nearing retirement age, they probably have many questions about Medicare. Are they supposed to switch to Medicare exactly at age 65? If they keep working, should they stay on the group plan their employer offers? As a licensed health insurance professional, you are in a key position to give your clients an objective Medicare comparison to group medical insurance. Learn more about your clients’ potential questions and prepare to address their specific concerns about Medicare and employment.
Important Terms for Your Clients to Know
Your 64-year-old clients may be struggling with the difference between Parts A, B, and C, understanding prescription drug coverage through Medicare, and knowing how Medicare Advantage fits into everything else. Here are terms you’ll want to familiarize them with before they make decisions:
- Medicare Parts A and B: This is the “original Medicare” from the 1965 law. Part A is hospital insurance, hospice, and nursing home coverage, while Part B covers appointments, tests, and other services you may expect from medical insurance.
- Part C (Medicare Advantage): These specific private insurance plans act as an alternative to Parts A and B.
- Part D: This part of the Medicare law covers prescriptions.
Typically, 65-year-olds who receive Social Security benefits are automatically enrolled in Part A. If they choose to keep working, they can choose between Medicare and a Medicare Advantage plan, which comes with its own network of doctors and different monthly premiums. Alternatively, they might opt to stay on their employer’s health insurance plan.
The Advantages of Medicare Over Group Health Insurance
Medicare can be significantly less expensive than group health insurance while providing more comprehensive coverage. Most doctors accept Medicare, which gives patients more choices when it comes to treating both simple and complex health conditions. In addition, individuals can usually self-refer to doctors and other specialists with a Medicare plan. Employer HMO plans may require specialist referrals from a primary care provider, which can add unnecessary time and frustration to a medical appointment.
Here are a few specific details to remember when comparing Medicare to group medical insurance.
Typical Cost When Using Group Medical Insurance
According to the Bureau of Labor Statistics, in 2024, employer-sponsored health insurance cost individuals around $121.80 per month and small business employers around $352.33 per month. Family coverage may total around $528.84 per month, while the employer contributes $1,232.59.
Medicare can be significantly less expensive than group health insurance while providing more comprehensive coverage.
There’s a wide range of deductibles, as well as monthly premiums, with employer plans. It’s important to consider the coinsurance or copay cost when your client is evaluating whether to keep employer-based insurance or switch to Medicare.
Typical Costs When Using Medicare and an MAPD
The original Medicare (Parts A and B) costs around $202.90 per month. This number usually reflects only the cost of Part B. Part A is $0 if the individual has paid Medicare taxes for at least 10 years. If they haven’t, there’s a cost associated with Part A, which is up to $518 per month. Medicare Advantage plans vary in what they offer, but the typical cost in 2026 is $17 per month. A Medicare Advantage prescription drug (MAPD) plan often costs around $38 per month in 2026.
Other Medicare FAQs Your Clients May Ask
Medicare enrollment has been high for the past decade as the baby boomer population has reached retirement age. However, many older adults continue to work past their 65th birthday. If your client doesn’t yet have plans to retire, answering these common questions could be an entry point to a conversation about future insurance plans.
How Do I Enroll in Medicare?
If your client is 65+ and receives Social Security benefits, they will automatically be enrolled in Medicare Part A (hospital coverage). They are eligible to sign up for Part B if they meet these criteria as well. If your client is employed, they can have dual coverage, where they hold both their employer’s group insurance and Medicare at the same time.
What’s the Right Age to Switch to Medicare?
Usually, it’s a good idea for people to sign up when they first become eligible. However, this is a highly individual decision that the client may want to discuss with their spouse, their health insurance professional, and perhaps their employer.
Do I Have to Switch to Medicare Even If I’m Working?
Some clients worry that they will be forced to choose Medicare upon their 65th birthday, regardless of their wishes to stick with their group insurance plan from their employer. It’s important to clarify that nobody forces this switch to Medicare. For people with employer-based health insurance, there’s no penalty for joining Medicare late. However, it’s a good idea to discuss your client’s goals and current health status to determine whether Medicare, their employer’s group insurance, or a dual enrollment plan would benefit them most. Some clients have the wrong impression of what Medicare does and does not cover for them.
What If My Dependent Spouse Is Not Working?
This is an important question to consider before switching to Medicare while employed. Non-working spouses cannot sign up for the same Medicare plan as their spouses because Medicare is an individual plan. The non-working spouse could sign up for Medicare if they are eligible. Sometimes, the employer will insist that the non-working spouse choose Medicare rather than remain a covered dependent on the group insurance plan. It’s a good idea to learn more about this plan, and for the client to speak with their employer, to determine how the employer usually handles the situation.
Have Informed Conversations with Your 64-Year-Old Clients
The transition to Medicare, especially when an older adult wishes to continue working past retirement age, can be a time of questions and concerns. While your clients may turn to the internet for answers, you, as a health insurance professional, are in a better position to guide them. Be prepared with the answers and give your clients sound, informed advice customized to their current stage in life.