As a business owner, sometimes retirement is the last thing on your mind, but it certainly is something that many workers approaching age 65 are cognizant of, especially around Medicare enrollment. Even those working past 65 will need to have a gameplan ready when it comes to Medicare. Most people have questions about the differences between Medicare Advantage and Medicare Supplement Insurance plans. With so many plan options, your employees may wonder which is right for them.

Both plans are designed to help your employees get the most out of Medicare benefits, but what’s best will depend on several factors. Making sure the plan has in-network coverage for their doctors and medications will be key to determining the best fit. It’s best to review the plan’s provider directory to see whether certain doctors are covered. Likewise, check to see if medications are included and how much they cost. It’s also important to see whether the medication can be mail-ordered and which pharmacies are covered.

Something else your employees may want to consider is the Star rating from the Centers for Medicare and Medicaid Services. These are determined yearly based on customer service, member experience with the health plan and how the plan helps members stay healthy by offering access to preventive care.

The basics of each plan: 

Medicare Advantage Plans

• Combine Medicare Parts A (hospital stays) and B (outpatient appointments and services) benefits and are sold by private insurers. 
• May include Part D prescription drug coverage. 
• Dental and vision included.
• Lower out-of-pocket costs than Original Medicare. 
• A network of doctors and hospitals members must use to take advantage of coverage. 
• When traveling outside the country, access to emergency coverage.

Medicare Supplement Insurance Plans

• Private insurers sell to “supplement” your Original Medicare coverage. 
• Help pay some of the out-of-pocket costs that Original Medicare doesn’t cover, such as deductibles, copays and coinsurance. 
• Sometimes offer emergency medical care while traveling outside the U.S.
• Enjoy access to any doctor that accepts Medicare without having to check if they are in-network.
• Do not cover prescription drugs and typically do not cover hearing aids, eyewear, dental or long-term care. 

Enrollment Periods

When is someone eligible to enroll in a Medicare Advantage or Supplement Insurance plan? There is a seven-month initial enrollment window, which starts three months before your 65^th birthday, includes your birthday month and ends three months after your birthday month.  This allows someone to enroll without being subject to medical underwriting; if enrolled later, however, they could be subject to a higher premium.

• Three months prior to your 65^th birthday month
• 65^th birthday month
• Three months following your 65^th birthday month

Every ear between October 15 – December 7, there is an Annual Enrollment Period (AEP) where anyone can opt to switch their Medicare coverage. This coverage would begin on January 1 the following year. There is also a Special Enrollment Period (SEP) that allows for coverage adjustments at any time for some of the following reasons (but are not limited to):

• Enrolled in a plan but moved out of the plan’s service area
• Eligible for both Medicare and Medicaid
• Entered a nursing home or facility
• Meet low-income requirements
• Left an employer group health plan

Learn More About Our Medicare Plans

If you or any of your employees are approaching age 65 or preparing for retirement, they may have questions about when to enroll in Medicare and what plan option are best for them. Medical Mutual's licensed agents are available to answer Medicare plan questions and discuss options. Medical Mutual offers a variety of Medicare Advantage and Medicare Supplement plans, as well as Individual and Family plans for those retiring before age 65. Contact a licensed agent at 1-800-732-3106 (TTY 711) to learn more or visit MedMutual.com/Medicare.

Founded in 1934, Medical Mutual is the oldest and one of the largest health insurance companies based in Ohio. We provide peace of mind to more than 1.2 million Ohioans through our high-quality health, life, disability, dental, vision, and accident and critical illness plans. We offer fully insured and self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement and Individual and Family plans. Medical Mutual’s status as a mutual company means we are owned by our members, not stockholders, so we don’t answer to Wall Street analysts or pay dividends to investors. Instead, we focus on developing products and services that help people live healthier through all stages of life. For more information, visit the company’s website at MedMutual.com.

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