Group Health Medicare Coverage

Wednesday, April 3, 2024 21:48 Posted by Admin

Whether you’re traveling the globe, trying out some new hobbies, or simply appreciating your newfound free time, there is so much enjoyment that comes along with retirement. Though, in order to truly take advantage of your time, it’s crucial that you find the ideal health coverage to ensure that your retirement is as secure and enjoyable as possible. One such way to do this is by obtaining a group health Medicare plan.

Group Health Medicare plans are employer-sponsored and offered to former employees, just like how they offer insurance plans to current employees. They are also referred to as Group Medicare Advantage plans or employer group waiver plans (EGWP). These plans combine the benefits of Original Medicare, with additional perks that Medicare doesn’t traditionally cover, such as wellness classes, travel coverage, dental, and hearing aid coverage.

Continue reading to learn more about group health Medicare coverage, the benefits that these plans may offer you and your family, and additional things to be aware of before signing up.

What is Group Health Medicare Coverage?

If you are recently retired or planning for your upcoming retirement, group health Medicare coverage is one of your many options. The most common form of group Medicare is known as Group Medicare Advantage, or employer group waiver plan (EGWP). Insurance experts refer to them as “egg-whips.”

Group Medicare Advantage plans are a type of insurance coverage that is offered to retirees by employers or unions. These plans are provided and managed by private insurance companies. With EGWPs, Medicare pays the private insurance company a set amount to issue benefits to retirees. The employer also generally pays the insurance company an extra amount in order to provide additional benefits.

When you’re enrolled in a Medicare Advantage plan, all the benefits under original Medicare is provided, including hospital and medical insurance coverage. Though, most plans come with a number of other health-related services, such as dental, vision, health and fitness programs, travel coverage, and more.

Who is Eligible for Group Health Medicare Coverage?

To be eligible for a group health Medicare plan, you have to be retired, enrolled in Medicare Parts A and B, and satisfy any additional requirements established by your company. These additional requirements may relate to your length of service or status, but will vary from company to company.

The best way to know if you’re eligible for a group Medicare plan is to speak with your employer. Fortunately, if you do not qualify for a group plan, there are a number of individual Medicare plans available that can give you the level of coverage and care that you need in your retirement.

What Do Group Health Medicare Plans Cover?

Group health Medicare, or Medicare Advantage, plans provide the same coverage as Medicare parts A, B, and D, which includes both hospital and medical insurance coverage, as well as additional health care. Depending on the plan that you enroll in, the following services may also be covered:

  • Vision, dental, hearing. These services are not provided under original Medicare and are deemed “non-medically necessary.” Though, the level of coverage you have regarding these options will vary depending on the Medicare Advantage plan you choose.
  • Prescription drug coverage. Though not traditionally provided under original Medicare, most group health Medicare plans provide prescription drug coverage. Some plans may even offer coverage for dependents and/or spouses who aren’t eligible for Medicare yet because of their age.

Most companies will also issue a variety of health-related perks under their Group Health Medicare plans. These may include such advantages as meal delivery, medical transport, gym memberships, travel coverage, and more.

Types of Group Health Medicare Plans

Based on your needs, there are numerous different types of group health Medicare plans that you can choose from. These include:

  • HMO Plans: HMO, or ‘Health Maintenance Organization,’ plans only allow you to get care from doctors and facilities that are in-network. You choose a primary care provider (PCP) that manages your care and then must obtain an out-of-network referral to see a specialist.
  • PPO Plans: With PPO, or ‘Preferred Provider Organization,’ plans, there are different rates for providers, hospitals, and doctors depending on whether they’re in- or out-of-network. You will always pay less for in-network services.
  • PFF Plans: With PFFS, or ‘Private Fee-for-Service,’ plans, you can receive health services from a provider of your choosing so long as they accept the payment terms and conditions outlined in your plan.
  • SNPs: SNPs stands for Special Needs Plans. These plans are offered to distinct groups of people that need long-term medical treatment for chronic conditions.
  • MSA Plans: MSA, or ‘Medicare savings account,’ plans pair a high deductible health plan (HDHP) with a health savings account (HSA). Medicare deposits money into the account to be used for future healthcare services.

According to the Kaiser Family Foundation (KFF), nearly 76 percent of Medicare Advantage health plans are PPOs.   

Advantages of Group Health Medicare Plans

One of the main advantages to Group Health Medicare Coverage is that plans generally offer members services that go beyond conventional Medicare Advantage plans, including:

  • Additional benefits
  • Cheaper out-of-pocket expenses
  • Health education

Medicare also permits special waivers to insurance companies and their Group Medicare plans, which apply to service areas, premiums, and enrollment periods. All of these waivers provide major advantages to you as a retiree.

How Much Does Group Health Medicare Coverage Cost?

The premium that you pay for Group Health Medicare coverage will vary based on how much your employer subsidizes the Medicare costs. It will also vary based on where you live and the plan that you choose.

While Medicare premiums are notoriously low, you will typically have a number of out-of-pocket costs that you will be responsible for. Though, there is usually an annual cap on most out-of-pocket expenses that help keep your overall costs relatively low.

Additional out-of-pocket expenses may include:

  • Deductibles: The deductible is the amount of money you are responsible for paying until your plan kicks in and starts paying your healthcare expenses. In most cases, this fee pertains to services other than doctor visits.
  • Coinsurance: Coinsurance refers to a percentage of the cost that you have to pay for a service after you’ve met your deductible. For example, if you have lab tests done, you may have to pay 20 percent while your plan pays the additional 80 percent.
  • Copays: Copays are fees that you must pay for services at the time of care. Depending on your plan, you may have to pay a copay each time you visit the doctor. Oftentimes, this fee is slightly higher for specialists.

The specific Group Health Medicare plan that you select will determine if you have to pay any of these out-of-pocket costs and if so, how much they will be.

How to Choose a Group Health Medicare Plan

Group Health Medicare plans can be an appealing advantage to you as a retiree. In some cases, by enrolling in your company’s plan, you may receive additional benefits that don’t come with conventional Medicare Advantage plans. Plus, you won’t have to worry about following the same rules regarding enrollment periods.

If your employer (or former employer) offers you Group Health Medicare coverage, consider the following before choosing a plan:

  • Your coverage needs. Make sure that you factor in the doctors you visit and the medications you need. This will help you narrow down a plan based on whether or not it covers your providers and prescriptions.
  • The location the plan covers. What is the geographic area that the plan applies to? Look for providers and facilities that are included in the network to save money.
  • The plan’s rating. With the Medicare Advantage Star Ratings program, plans are rated on a scale that goes up to five stars. Use this rating program when choosing a plan. Those that are rated four or five stars are considered high-quality.

Since Group Health Medicare plans are customized according to the business, government entity, or union, you’ll likely be able to do the majority of your research by speaking with your company’s benefits office or the insurance company directly.

Have more questions about group health Medicare coverage? You’ve come to the right place. Whether you’re an employer looking for the ideal group Medicare benefits package for your employees or you’re a retiree trying to understand your options, the team at Taylor Benefits Insurance Agency can help.

So, what are you waiting for? Don’t hesitate – contact us now to get started.

Written by Todd Taylor

Todd Taylor

Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.

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