Senior woman checks her bills for late fees

Retiree Plans and Cobra are not Creditable Coverage for Medicare

DID YOU KNOW? Retiree Plans and Cobra are not Creditable Coverage for Medicare

Too many retirees are getting hit with late enrollment penalties for Medicare

Too many retirees are getting hit with late enrollment penalties for Medicare, finding themselves with medical bills that are not being paid and being talked into plans that, frankly, don’t work for them.  Once an employee becomes a retiree of a company, they are often handed over to a third-party benefits administrator who really doesn’t take the time to explain their rights and what they need to do and when they need to do it.

I have been on many calls with people who are either retiring, or are retired, from a company and then handed off to a third-party benefits administrator who then transfers us to one person, then to another, then to another, and then back to the original person. In the meantime, the retiree, my client, is feeling frustrated, angry, and scared, that they will end up being penalized for just having decided to take the step of retirement. This is insane and it happens repeatedly for people in mid-size, large, and often government related industries.

If you do not take the steps to enroll in Part B when first eligible, you will owe a late enrollment penalty!

Did you know that COBRA and RETIREE Insurance are not forms of job-based health insurance coverage and, if you do not take the steps to enroll in Part B when first eligible, you will owe a late enrollment penalty?  Medicare requires that you show continuous creditable coverage if you and your spouse are covered by group-based health insurance and are staying with that coverage and not enrolling in Medicare Part B.  What many companies fail to explain well to their retirees is that group coverage only counts as creditable while they are working for that company.  Once they retire, they must enroll in Medicare Parts A and B to avoid late enrollment penalties.  Please click on this link (or copy and paste it) to read further: Medicare-Part-B-SEP.docx (

Late enrollment penalties for Part B can add up over time and can cause you to have much higher than expected medical costs.  It also can affect when you can enroll in Medicare and could cause penalties for prescription drug coverage as well.

Employers are relying more and more on third party benefits administrators to relay information to their retirees and those third party benefits people are handling benefits for many companies and unions and are not communicating well with the retirees.  Employees need to be demanding more of their company, their union, and their government to make sure that they are not left with high bills that they cannot afford because consistent and understandable information regarding their Medicare rights was not made available to them.

How much does a health insurance agent cost?

How Much Does a Health Insurance Agent Cost?

How Much Does a Health Insurance Agent Cost?

Insurance plans are extremely difficult to understand without a helpful agent.

Costs are a serious concern for people who need to shop for individual or Medicare insurance plans. Some are worried that even just calling an insurance agent will come at a cost, so they attempt to manage the process on their own. What those individuals quickly learn is that insurance plans are extremely difficult to understand without a helpful agent to interpret them.

It costs you nothing to work with a health insurance agent in Pennsylvania!

Here’s the good news: it costs you nothing to work with a health insurance agent in Pennsylvania. In fact, you may be able to save money, time, and many headaches by working with an agent. There are several reasons why working with a health insurance agent can make insurance and healthcare more affordable.

Insurance Agent Fees are Covered in Premiums

Independent insurance agents get paid commissions by the health insurance companies. These agent commissions are built right into the premium you pay for your plan. This means that even if you are not working with an insurance agent, you are paying for one. But you are missing the guidance and service an agent provides.

Because agents are paid commissions through premiums, do they simply steer all clients towards the highest paying plans? The short answer to this is no. Your health insurance agent has a responsibility to work in your best interest, not their own. You can go over the commission they will receive in each plan you are reviewing, and you will quickly notice that the agent’s recommendations are in alignment with your needs rather than their potential earnings.

Insurance Agents Look at All of Your Costs

While the health insurance premiums may be your focus when pricing plans, a knowledgeable agent is looking at a bigger picture of costs. They’ll explain what you will pay to actually use your plan in a medical setting. Your premium, though it’s the known upfront cost, is just one element of your overall healthcare expenses.

Experienced health insurance agents will ask you about how you have used healthcare in the past and how you expect to continue using it. They will explain your deductibles, co-pays, out-of-network costs, and limits to coverage. Once you see the entire scope of coverage for your premium, you will have a better sense of what healthcare will really cost under each plan.

Insurance Agents Save You Time and Frustration

Today’s plans are far more complex.

Health insurance policies used to be so straightforward that you could call any medical provider and find out if they accepted your plan. Today’s plans are far more complex. Providers may participate with only certain policies under a given insurer. The insurers offer some plans with a large network of providers, but others – of very similar sounding names – with only a narrow network of providers. Whether you call the provider directly or search online, it’s easy to get confused about whether or not a given provider accepts your specific plan. This is especially common with Medicare Advantage Plans, Individual and Family Insurance Plans that are sold either on or off the Marketplace, and small group plans. Once enrolled, you are typically locked into a plan for one year. It’s very frustrating to discover that the providers you thought were in the plan’s network are actually not covered.

An experienced local health insurance agent helps you identify the right plan for your needs and also helps you navigate the plan you choose. Our job is to interpret the coverage, costs, and network providers so that you can make the most informed decision about enrollment. At Real Health Quotes, we continue providing helpful guidance even after you enroll in the plan. Whenever you have a question about providers, coverage, premiums, or a claim, you can give us a call. Our job is to make sure you know what to expect in your healthcare so that you can avoid the cost (in time or money) of mistakes and correcting them.

Our job is to make sure you know what to expect in your healthcare so that you can avoid the cost (in time or money) of mistakes and correcting them.

How Much Will Medicare Cost Me?

How Much Will Medicare Cost Me?

For most people approaching age 65, enrolling in Medicare will be their very first experience of purchasing health insurance on their own. They are typically more familiar with participating in an employer sponsored plan. Medicare is something very new to them, and all they know so far is that they could be penalized for enrolling late or incorrectly and that there are different “parts” they need to review.

The main concern for most individuals is cost. Having paid for health insurance all of their working life, and knowing that healthcare costs rise as we age, they are worried about how they will pay for insurance in their later years. Medicare is specifically designed for aging individuals and has many subsidies due to the tax dollars those individuals have already paid into the system. Each Medicare part is priced separately. Let’s start with the cost of original Medicare, which is Part A and Part B.

How Much Will Medicare Part A Cost Me?

Medicare Part A is hospital insurance, and most people (with some exceptions) will not need to pay a premium for it. Because there is typically no premium, it is wise to enroll in Medicare Part A at eligibility (up to 3 months before one’s 65th birthday) even if the individual is still participating in an employer’s plan.

Medicare Part A premiums are covered because either the individual or their spouse has already paid Medicare taxes for at least 10 years while earning W-2 income. If that tax-paying history does not exist, the individual will pay monthly premiums for Medicare Part A. This often affects recent immigrants, and the payment is either $278 or $506 in 2023.

Medicare Part A does have deductibles and copays that individuals will pay out of pocket for inpatient hospital care, skilled nursing services, and home health care medical equipment. The deductible in 2023 for an inpatient hospital stay is $1,600. Copayments are based on the amount of time spent receiving care. Home health care and hospice care covered under Medicare do not have a deductible or copay.

How Much Will Medicare Part B Cost Me?

Medicare Part B is outpatient medical insurance. Medicare Part B covers doctor visits, lab work, durable medical equipment, home health care, Part B drug administration, outpatient surgery, and other outpatient care. This premium is $164.90 per month in 2023 for individuals earning $97,000 or less and married couples filing jointly earning $194,000 or less. Premiums are higher for those who earn more.

The premiums are based on the income earned 2 years prior to the current year, so premiums can change from year to year. Individuals who are eligible for Medicaid, or state assistance due to low income, may not have Medicare Part B premiums. If someone has a life event that impacts their income for assessing Medicare premiums, they can file Form SSA-44 to try to pay a lower amount. Medicare Part B also has deductibles and copayments depending on the type of care, including a low annual deductible.

How Much Will Medicare Part C Cost Me?

Medicare Part C is not an actual benefit, but rather the classification of Medicare Advantage plans. These plans are sold by private insurers and offer many options for coverage, benefits, and premiums. No one is required to enroll in a Medicare Advantage plan.

Medicare Advantage plans replace original Medicare.

Medicare Advantage plans replace original Medicare. They are not Medicare Supplement plans. Through deceptive marketing practices, people are led to believe that Medicare Advantage supplements their original Medicare coverage, and this is simply not true. It is a completely separate product. It is always vital to speak with a trusted Medicare insurance agent about existing coverage and what has been offered or promised.

How Much Will Medicare Part D Cost Me?

Medicare Part D covers prescription drug plans. These plans are not technically required, but there is a penalty that can extend over a lifetime for not enrolling. Alternative coverage such as VA coverage, TriCare, creditable employer prescription drug coverage, or low income assistance will exempt an individual from the penalty. If someone does not enroll in prescription drug coverage during open enrollment, or within 63 days of losing creditable coverage, they will be fined 1% of the average annual cost of a Medicare prescription drug plan for each month of coverage missed every month for life.

What are the Financial Penalties of Not Enrolling in Medicare?

Late enrollment penalties are assessed if a person does not have coverage that is at least as good as original Medicare and misses the open enrollment period. The penalty will be assessed for either double the number of years of coverage missed (Part A) or the lifetime of coverage (Part B and D). To avoid unnecessary penalties, always take advantage of the initial enrollment period at age 65.

At Real Health Quotes, we are experienced advisors who will answer all of your Medicare questions

There is no cost to talk to an insurance agent about Medicare. At Real Health Quotes, we are experienced advisors who will answer all of your Medicare questions, help you understand the bottom line to everything you’ve seen and heard about Medicare, and guide you through the enrollment process and beyond. You do not need to figure out Medicare all on your own.

Contact us to learn more about your options and explore the best coverage for you.

Want to learn more about Medicare?

Sign up for our “What You Need to Know about Medicare in 6 Easy Steps” course! Learn more and sign up here.

What Tests or Procedures Are Covered Under Medicare?

A doctor tells you that you may need a test or procedure done and, after leaving the office, you begin to worry if that test is covered under your Medicare plan.  This is a worry for everyone but especially for new people coming into Medicare.  Having seen many things denied, or having gotten into a fight with their commercial insurance company prior to joining Medicare,  it is understandable that this worry comes up.  Did you know that there is a Medicare app called “What’s Covered?” that is available on both the Apple Store and Google Play?

This app allows you to search procedures and tests already listed in their database and allows you to type in procedures by name.  It also covers preventive services and the frequencies in which you may have them done.  Some services do require your Medicare participating physician to get a pre-authorization before the service is done.  It never hurts to make sure they have done so.

As for coverage with your Medicare Supplement Plan – if Medicare covers the service and has pre-authorized it for you (again check with your doctor) then your Medicare Supplement plan must also pay the remaining balance.  The Supplement cannot say “No!”, to a Medicare approved service.

Medicare Advantage plan members are the exception...

If you are covered under a Medicare Advantage plan, this application won’t be accurate for you.  While you are still part of the Medicare system, it is up to the commercial insurer who offers you coverage under the Part C Medicare Advantage Plan, whether it will be covered or not.  In that case always check with your physician and your insurer if you have any questions on whether a test or procedure is covered and how it will be covered.

The Sandwich Generation on Serving Aging Parents

It’s nearly impossible to read all of the health insurance information available to you. We know; we’ve already read most of it!

If you’re over 50, there’s a good chance you’ve spent the last few years trying to figure out how to help your parents with their Medicare questions while wondering if your own coverage is still right for your changing household dynamics.

This is exactly the right time to ask questions and explore your options! Whether you want to make sure your aging parents have the right coverage, or you want to start preparing for your own Medicare plan.