# Medicare question **URL:** \ **Category:** In My Humble Opinion\ **Created:** [August 5, 2016, 8:42pm UTC](https://boards.straightdope.com/t/medicare-question/761874 "2016-08-05T20:42:12Z")\ **Posts on this page:** 15\ **Page:** 2
**Author:** ![Lare](https://avatars.discourse-cdn.com/v4/letter/l/53a042/32.png) [@Lare](https://boards.straightdope.com/u/Lare)\ **Post date:** [August 7, 2016, 4:20pm UTC](https://boards.straightdope.com/t/medicare-question/761874/21 "2016-08-07T16:20:05Z")
I am old enough to remember yellow pages and just a bit too young to have started looking into Medicare. But it’s getting closer, so I opened the thread. Please excuse what may be a very dumb question, but what \* kind \* of agent am I going to look for? In other words, what search term should I start with? ---
**Author:** ![NAF1138](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/naf1138/32/3245_2.png) [@NAF1138](https://boards.straightdope.com/u/NAF1138)\ **Post date:** [August 7, 2016, 4:36pm UTC](https://boards.straightdope.com/t/medicare-question/761874/22 "2016-08-07T16:36:59Z")
> [@Lare](#): > > I am old enough to remember yellow pages and just a bit too young to have started looking into Medicare. But it’s getting closer, so I opened the thread. > > Please excuse what may be a very dumb question, but what \* kind \* of agent am I going to look for? In other words, what search term should I start with? You want someone who specializes in Medicare. Senior services companies usually. You are often better off with someone who does only or mostly only Medicare rather than someone who is using Medicare as a way to generate leads for life and annuity sales. Again, I highly suggest looking up agents on your department of insurance website. You can (usually)\* see all the companies they are contracted with, how long they have had a license. All sorts of stuff. \*varies by state. Indiana, for example, doesn’t release much agent info at all. PA, where I live, will give you my home address. ---
**Author:** ![dreamregent](https://avatars.discourse-cdn.com/v4/letter/d/6f9a4e/32.png) [@dreamregent](https://boards.straightdope.com/u/dreamregent)\ **Post date:** [August 7, 2016, 4:53pm UTC](https://boards.straightdope.com/t/medicare-question/761874/23 "2016-08-07T16:53:52Z")
> [@Lare](#): > > I am old enough to remember yellow pages and just a bit too young to have started looking into Medicare. But it’s getting closer, so I opened the thread. > > Please excuse what may be a very dumb question, but what \* kind \* of agent am I going to look for? In other words, what search term should I start with? “Medicare insurance” or “Medicare agent” should do the trick. However, I would suggest you first try asking friends who have been through this for recommendations. Often, these are captive agents who market only one company so I would try to find one who represents many, rather than go through this process with a bunch of different people. I suggest asking friends for recommendations rather than conducting a blind search because there is a trust factor here. If your friend believes he or she can trust this person, it’s probably more likely that you can trust the person. Unfortunately, there are people in this business who care more for their own benefit than yours. It’s sad but true. ---
**Author:** ![FairyChatMom](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/fairychatmom/32/21906_2.png) [@FairyChatMom](https://boards.straightdope.com/u/FairyChatMom)\ **Post date:** [August 7, 2016, 5:08pm UTC](https://boards.straightdope.com/t/medicare-question/761874/24 "2016-08-07T17:08:06Z")
I’m older than my husband and as a retired Federal employee, I carried our health insurance into retirement. When I turn 65, he’ll just be 62, so he’ll need coverage for 3 more years. Will a Medicare agent be my best bet to figure out what to do, or should I try to get answers from OPM? Or maybe AARP? I’ve got time, but I don’t want to wait till the last minute either. ---
**Author:** ![NAF1138](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/naf1138/32/3245_2.png) [@NAF1138](https://boards.straightdope.com/u/NAF1138)\ **Post date:** [August 7, 2016, 5:10pm UTC](https://boards.straightdope.com/t/medicare-question/761874/25 "2016-08-07T17:10:16Z")
> [@dreamregent](#): > > Unfortunately, there are people in this business who care more for their own benefit than yours. It’s sad but true. This is why I tend to recommend against working with agents who have only been doing this a year or two. It’s totally unfair because there are plenty of new agents who are good, but, if you have managed to not fail out of the business after a couple of years you probably know what you are doing and are looking out for your client. It isn’t universally true, but it’s a good indicator. ---
**Author:** ![samclem](https://avatars.discourse-cdn.com/v4/letter/s/a9a28c/32.png) [@samclem](https://boards.straightdope.com/u/samclem)\ **Post date:** [August 7, 2016, 5:23pm UTC](https://boards.straightdope.com/t/medicare-question/761874/26 "2016-08-07T17:23:57Z")
> [@dreamregent](#): > > As for the Part A penalty, another poster mentioned this above: > > However, see what the text says at the link sevenwood provided: > > Note the phrase at the beginning. Most people do not pay a premium for Part A because they get it premium-free due to working. The monthly premium most people pay is for Part B, not Part A. Hence, if you’re not paying a premium for this part of the coverage, you wouldn’t have a penalty on that part anyway. This is also probably not the concern here because this gentleman is working. Exactly. He’s been working and paid medicare taxes. He will NOT be charged when he signs up for Part A. He need not sign up for part B if his company has more than 20 employees. If 19 or less, he HAS to sign up for part B. I went through this when I turned 65 seven years ago. I’m still working. ---
**Author:** ![dreamregent](https://avatars.discourse-cdn.com/v4/letter/d/6f9a4e/32.png) [@dreamregent](https://boards.straightdope.com/u/dreamregent)\ **Post date:** [August 7, 2016, 5:49pm UTC](https://boards.straightdope.com/t/medicare-question/761874/27 "2016-08-07T17:49:20Z")
> [@FairyChatMom](#): > > I’m older than my husband and as a retired Federal employee, I carried our health insurance into retirement. When I turn 65, he’ll just be 62, so he’ll need coverage for 3 more years. > > Will a Medicare agent be my best bet to figure out what to do, or should I try to get answers from OPM? Or maybe AARP? I’ve got time, but I don’t want to wait till the last minute either. Government employees often have great retirement benefits. OPM has **[a website](https://www.opm.gov/healthcare-insurance/healthcare/medicare/)** devoted to this. Note the extensive links along the right side. While it never hurts to consult a knowledgeable agent, I would familiarize yourself with this material before you do so. There are cases where retirees are receiving benefits for which Medicare plans may offer little or no coverage. You must consider this as well. If the price isn’t a dire concern and you like the coverage you have, there may be no reason to change. It’s good that you have the desire to educate yourself on the pros and cons of various approaches though. There are far too many people who don’t even like thinking about it. ---
**Author:** ![NAF1138](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/naf1138/32/3245_2.png) [@NAF1138](https://boards.straightdope.com/u/NAF1138)\ **Post date:** [August 7, 2016, 6:46pm UTC](https://boards.straightdope.com/t/medicare-question/761874/28 "2016-08-07T18:46:44Z")
> [@Take your disease home and DIE rude fucker!](https://boards.straightdope.com/t/take-your-disease-home-and-die-rude-fucker/101043/19): > > Will a Medicare agent be my best bet to figure out what to do, or should I try to get answers from OPM? Or maybe AARP? I’ve got time, but I don’t want to wait till the last minute either. Contact AARP? Can I soapbox for a second? Since I figure most people reading this are either insurance professionals or people who are in AARPs demographic. **Dreamregent** gave a good response to this actual question already so if you will indulge me: (ahem) AARP IS A MARKETING ORGANIZATION WHO’S PRIMARY PURPOSE IS TO SELL STUFF TO SENIORS. DO NOT GO TO THEM FOR ADVICE!!! Okay, got that out of my system. Aarp does good stuff as an advocacy organization. But they are not the place to turn to for advice on anything else. They sell their endorsement to the highest bidder. On the other hand calling Medicare directly is actually a really great experience. Don’t call during business hours, but they are open 24/7 and if you call at like 8 or 9pm eastern things are usually pretty slow. They are actually neutral and usually fairly knowledgeable. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [August 7, 2016, 8:14pm UTC](https://boards.straightdope.com/t/medicare-question/761874/29 "2016-08-07T20:14:48Z")
> [@Mean\_Mr.Mustard](#): > > So now that I know, Why the “MAY” in your second paragraph. Seems to me, if you are still working you don’t need medicare. Is there a scenario in which one might work and still enroll (paying the 121 per month)? Some employer health insurance plans, especially those for small employers (less than 20 employees), either don’t cover Medicare-eligible employees at all or cover them differently than they do regular employees. If you are still working, but have one of these plans, it’s to your benefit to pay that $121/mo. Also, if your employer plan is very expensive, you might get better and/or cheaper coverage from Medicare. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [August 7, 2016, 8:31pm UTC](https://boards.straightdope.com/t/medicare-question/761874/30 "2016-08-07T20:31:31Z")
> [@NAF1138](#): > > … > There is also the issue of, is your husband better off on his employer plan? Medicare with a plan F supplement (or even plan G or N) us usually better health insurance than a group plan and it’s also usually cheaper ( **at least in my state** ). For my clients I find the break even point is about 2k per year. If your premium for the group plan plus your copay and deductible are less than 2k per year you are better off sticking with the employer plan. … When you refer to “your premium”, are you talking the employee’s portion only, or the employee + employer version? I’m guessing the employee portion only, just checking. I bolded “in my state” because that’s a very important distinction. We own a condo in Florida (for the in-laws) and we live and work in Virginia. My employer’s retiree health benefits consist of money they put aside for me that can be used to fund medigap premiums, and a few months ago I was playing around with plan costs (we’re 8 years away from Medicare being an option, I was just curious). The costs in Florida would be _significantly_ higher than in Virginia. > [@teela brown](#): > > His current employer says that he can continue his current insurance plan with them even after retirement. Beware that could change in the future. Employers are not legally bound to offer such coverage, and can terminate that whenever they wish. Plus, if he retires who pays the employer’s portion? I know THAT isn’t the most pressing scenario since I gather you could switch to Medicare if that happened (BTW, how old are _you_? If you’re under 65 when he retires, how will you get coverage?). ---
**Author:** ![NAF1138](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/naf1138/32/3245_2.png) [@NAF1138](https://boards.straightdope.com/u/NAF1138)\ **Post date:** [August 7, 2016, 8:57pm UTC](https://boards.straightdope.com/t/medicare-question/761874/31 "2016-08-07T20:57:30Z")
> [@Mama\_Zappa](#): > > When you refer to “your premium”, are you talking the employee’s portion only, or the employee + employer version? I’m guessing the employee portion only, just checking. > > I bolded “in my state” because that’s a very important distinction. I am only talking about your own costs. The idea is to try to save your money while increasing your benefits. Odds are Medicare and a supplement is going to be better insurance than what your employer offers, but depending on your current cost and risk it’s possible that it doesn’t matter that it’s better. And yes, this is hyper state specific. Medical insurance can vary wildly from state to state. Medicare supplements usually won’t and traditional Medicare won’t, but Medicare Advantage and RX plans will and your employer sponsored heal plans sure as heck will. ---
**Author:** ![dreamregent](https://avatars.discourse-cdn.com/v4/letter/d/6f9a4e/32.png) [@dreamregent](https://boards.straightdope.com/u/dreamregent)\ **Post date:** [August 7, 2016, 9:10pm UTC](https://boards.straightdope.com/t/medicare-question/761874/32 "2016-08-07T21:10:55Z")
> [@NAF1138](#): > > Contact AARP? > > Can I soapbox for a second? Since I figure most people reading this are either insurance professionals or people who are in AARPs demographic. **Dreamregent** gave a good response to this actual question already so if you will indulge me: (ahem) > > AARP IS A MARKETING ORGANIZATION WHO’S PRIMARY PURPOSE IS TO SELL STUFF TO SENIORS. DO NOT GO TO THEM FOR ADVICE!!! > > Okay, got that out of my system. Aarp does good stuff as an advocacy organization. But they are not the place to turn to for advice on anything else. They sell their endorsement to the highest bidder. I would second this. Given AARP’s position and potential for influencing the decisions of seniors, I don’t think they should even be permitted to offer paid endorsements of a particular company’s Medicare products. The company they’ve endorsed is great but their product line is not a panacea for all of AARP’s members. Supplements are subject to less regulation but I’m kind of surprised CMS allowed them to attach an AARP membership to the sale of the product. I’m even more baffled as to why they would allow the Medicare Advantage plans to be branded as “AARP” plans. To someone who loves AARP, this may give the impression of “better” or “best” and that’s a characterization CMS doesn’t otherwise permit in terms of marketing those products. AARP isn’t actually saying that here but I think some people do get this impression. While I’ve marketed these plans in appropriate circumstances, I’ve had people explicitly ask why I didn’t offer them after suggesting something else in a given situation. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [August 8, 2016, 12:53am UTC](https://boards.straightdope.com/t/medicare-question/761874/33 "2016-08-08T00:53:36Z")
> [@FairyChatMom](#): > > I’m older than my husband and as a retired Federal employee, I carried our health insurance into retirement. When I turn 65, he’ll just be 62, so he’ll need coverage for 3 more years. > > Will a Medicare agent be my best bet to figure out what to do, or should I try to get answers from OPM? Or maybe AARP? I’ve got time, but I don’t want to wait till the last minute either. > **[Eligibility](https://www.opm.gov/healthcare-insurance/healthcare/eligibility/)** > > A description of Eligibility requirements for employees, retirees and survivor anniuitants, Temporary Continuation of Coverage, dependents, former spouses, CHAMPUS, TRICARE, and Tricare-for-life, and civilian employees on active military duty. > **[Eligibility](https://www.opm.gov/healthcare-insurance/healthcare/eligibility/#url=Annuitants)** > > A description of Eligibility requirements for employees, retirees and survivor anniuitants, Temporary Continuation of Coverage, dependents, former spouses, CHAMPUS, TRICARE, and Tricare-for-life, and civilian employees on active military duty. They’re not real clear on your specific situation. From the linked PDF: How Medicare Affects Your Health Benefits Coverage Because many people covered by the Federal Employees Health Benefits (FEHB) plans also have Medicare coverage (or other group health insurance or no-fault automobile protection), all FEHB plans have a coordination of benefits or double coverage provision. The purpose of this provision is to enable enrollees and covered family members to recover as much of their health care expenses as their total coverage permits, but not more than the actual charges for the care. Under the coordination of benefits (COB), or double coverage provision, one plan normally pays its benefits in full as the primary payer and the other plan pays a reduced benefit as the secondary payer. There’s a mention of another publication in that document. I’d definitely suggest contacting OPM to find out. My WAG is that you can continue to pay premiums and keep him covered one way or another, but it’s not something to mess around with. ---
**Author:** ![dreamregent](https://avatars.discourse-cdn.com/v4/letter/d/6f9a4e/32.png) [@dreamregent](https://boards.straightdope.com/u/dreamregent)\ **Post date:** [August 8, 2016, 5:02am UTC](https://boards.straightdope.com/t/medicare-question/761874/34 "2016-08-08T05:02:25Z")
> [@Mama\_Zappa](#): > > [Eligibility](https://www.opm.gov/healthcare-insurance/healthcare/eligibility/) > [Eligibility](https://www.opm.gov/healthcare-insurance/healthcare/eligibility/#url=Annuitants) > They’re not real clear on your specific situation. From the linked PDF: > How Medicare Affects Your Health Benefits Coverage > Because many people covered by the Federal Employees Health Benefits (FEHB) plans also have Medicare coverage (or other group health insurance or no-fault automobile protection), all FEHB plans have a coordination of benefits or double coverage provision. The purpose of this provision is to enable enrollees and covered family members to recover as much of their health care expenses as their total coverage permits, but not more than the actual charges for the care. Under the coordination of benefits (COB), or double coverage provision, one plan normally pays its benefits in full as the primary payer and the other plan pays a reduced benefit as the secondary payer. > There’s a mention of another publication in that document. > > I’d definitely suggest contacting OPM to find out. My WAG is that you can continue to pay premiums and keep him covered one way or another, but it’s not something to mess around with. First, I’m citing the PDF documents you mentioned in this post: _**[Information for Retirees and Survivor Annuitants](https://www.opm.gov/healthcare-insurance/healthcare/eligibility/information-for-retirees-and-survivor-annuitants.pdf)**_ (referenced as IRSA below) _**[The Federal Employees Health Benefits Program and Medicare](The Federal Employees Health Benefits Program and Medicare)**_ (referenced as FEHBPM below) FairyChatMom has concerns but the passage cited above really isn’t the most important thing. Note that her situation is entirely different from that of the OP, who intends to remain actively employed past age 65. FairyChatMom is already retired and on a retiree health plan now, prior to age 65. Hence, she has to make decisions as soon as she reaches Medicare eligibility which the OP can put off until he retires. I don’t know what type of plan she has, what the benefits are or how much it costs so I couldn’t give her specific advice but there are things of utmost importance which need to be considered. She should get Part A of Medicare premium-free but should she enroll in Part B? If she intends to keep the retiree plan, maybe, maybe not. However, if she doesn’t take it during the first period of eligibility but then decides to take it down the road for some reason, she will have to pay the penalty (FEHBPM, 7). Also, most retiree health benefits come with the caveat that if you reject them to use the Medicare system exclusively, you lose the retiree benefit forever. This federal retiree coverage has a caveat that’s a bit different. It allows you to suspend the benefit while insured under certain types of alternative coverage, like Medicaid, Tricare or Medicare Advantage. Under those scenarios, she could go back to the retiree benefit down the line if she needed to. Note, however, that disenrolling in favor of Original Medicare paired with a supplement is not mentioned in that list of scenarios (FEHBPM, 12; IRSA, 8-10). Hence, she would presumably lose the option to go back if she elects that route (IRSA, 10). There are other things to consider which depend on the type of plan she currently has and whether she wants to keep it in the future. For instance, from IRSA (26-27): > [@](#): > > If you (and your spouse) have both parts of Medicare (Part A-Hospital Insurance and Part B-Medical Insurance) and you are enrolled in an FEHB Fee-For-Service plan, you may have almost complete coverage for all medical expenses. > > If you are enrolled in an FEHB HMO, you may not receive added value by enrolling in Medicare Part B. However, you may consider enrolling in Part B because it:[ul] > [li]pays for costs involved with seeing outside doctors;[/li][li]pays for costs for non-emergency care in the U.S. if travel is involved; and[/li][li]is required for Medicare Advantage and TRICARE for Life.[/li][/ul] Also, there may be things which are covered under her retiree benefits which are not covered by Medicare, or vice versa (FEHBPM, 4-5). Really, it’s a matter of sitting down and thinking both about what one wants from a healthcare delivery system, whether there are certain benefits someone feels he or she needs, how much the current coverage costs vs. other set-ups (both the premiums and the out-of-pockets) and how much risk one is willing to accept in regard to his or her future health. It’s not a decision to be taken lightly but it sounds like she’s trying to educate herself early and that’s a great thing. Before calling OPM with blind questions, I would suggest reading everything she can get her hands on first. Then, she will be more informed and better able to compose questions which drill down to the points most important to her. The same thing goes for consulting with an agent. From my perspective, it’s far easier to educate a consumer when they already have at least a passing familiarity with what I am talking about. And from the perspective of consumers, they have a better understanding of what I’ve told them. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [August 11, 2016, 12:32pm UTC](https://boards.straightdope.com/t/medicare-question/761874/35 "2016-08-11T12:32:13Z")
Folks are mentioning FEHB (Federal Employee Health Benefit) plans, which have different guidelines than employment-based group health plans, so that is something to keep in mind (unless **teela brown** is a federal employee, in which case ignore the below.) The [CMS Website](https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html) is pretty clear on the guidelines for “Working Aged” (I know…) who continue to work after age 65 for an employer with a group health plan. I had to double-check them since I left employment with Medicare a decade ago and didn’t know if the laws had changed (they haven’t). > [@](#): > > Working Aged (Medicare beneficiaries age 65 or older) and Employer Group Health Plan (GHP): > > Individual is age 65 or older, is covered by a GHP through current employment or spouse’s current employment AND the employer has less than 20 employees: > [ul][li] Medicare pays Primary, GHP pays secondary[/INDENT][/li][/ul] > > Individual is age 65 or older, is covered by a GHP through current employment or spouse’s current employment AND the employer has 20 or more employees (or at least one employer is a multi-employer group that employs 20 or more individuals): > [ul][li] GHP pays Primary, Medicare pays secondary[/ul][/li]Individual is age 65 or older, is self-employed and covered by a GHP through current employment or spouse’s current employment AND the employer has 20 or more employees (or at least one employer is a multi-employer group that employs 20 or more individuals): > [ul][li] GHP pays Primary, Medicare pays secondary[/ul][/li] [Previous page](https://boards.straightdope.com/t/medicare-question/761874.md?page=1)