Before You Choose to Enroll In an Employer-Sponsored Medicare Group Plan, There Are a Few Things to Investigate First

Published on July 22, 2021

Enrolling in Medicare is an important step for seniors, and you can help them choose which plan is right for them.

Medicare is a federal government program that provides medical insurance to U.S. citizens and long-term residents. Medicare recipients are typically senior citizens over the age of 65. Once a person approaches the age of 65, they need to start considering their enrollment in Medicare. Some people may be eligible for Medicare benefits if they have been diagnosed with certain illnesses or if they have been placed on long-term disability.

Medicare offers several different plans, which provide coverage for certain medical expenses. Medicare also sometimes works with employers and unions to offer employer-sponsored Medicare group plans. Suppose a senior client is employed by one of these companies that participate in the Medicare sponsor program. You as an insurance agent could help them decipher which option is right for them, standard Medicare, or sponsored Medicare.

What Is an Employer-Sponsored Medicare Plan?

Any American citizen over the age of 65 is likely eligible for Medicare enrollment, but the same cannot be said for employer-sponsored Medicare plans. Employer (or union) sponsored Medicare is reserved for employees of the providing company. If a senior is eligible for either option, assisting them in their decision could be very helpful.

The Center of Medicare and Medicaid Services is responsible for overseeing all Medicare plans, and employer-sponsored plans are no exception. Their monitoring ensures senior rights are protected under all Medicare plans. However, not all plans come with the same coverages or costs.

What Do Employer-Sponsored Medicare Plans Cover?

Typically, employer-sponsored Medicare plans carry all the benefits of standard Medicare plans. These include all the advantages of Medicare plans A and B, which cover hospital stays and medical insurance for qualifying procedures and care.

⦁ Hospital stays
⦁ Rehabilitation facilities
⦁ Short-term nursing homes
⦁ Hospice services
⦁ Doctor appointments
⦁ Medical treatments
⦁ Lab services and testing
⦁ X-rays
⦁ Ambulance rides
⦁ Outpatient health services
⦁ Mental health care
⦁ Some medical equipment (wheelchairs and hospital beds)

It is also standard for most prescription drugs to be covered; however, there are exceptions, and seniors should talk to their insurance professionals to confirm their medications are adequately covered. Employer-sponsored Medicare plans can also provide additional coverages that standard Medicare overlooks. Some of these include specific prescription drug costs, dental checkups and cleanings, optometrist checkups, and hearing aids.

Do Standard Medicare Plans and Employer-Sponsored Medicare Cost the Same?

Perhaps the most significant difference between Medicare and employer-sponsored Medicare plans is the maximum out-of-pocket limitation. Medicare sponsored by unions or employers limit the amount of money a senior citizen pays for medical services throughout the year. Standard Medicare plans do not necessarily have a maximum out-of-pocket cap. It is also typical for employer-sponsored Medicare plans to establish cost-sharing. Cost-sharing means the Medicare recipient may not be solely responsible for copays and deductibles.

Some companies and unions offer to assist in the payment of Medicare’s monthly premiums. Many sponsored Medicare plans belong to participating network providers. If a sponsored Medicare plan works within one of these organized plans, a senior may be confined to receiving medical care from within that specific network. The cost of seeking treatment outside of the pre-approved network can be costly.

Final Thoughts

Medicare can be a very positive tool to secure a retiree’s healthcare benefits. The details can be hard to navigate, however. The licensed agents at American Senior Benefits prioritize assisting their valued senior clients. They take pride in their vast knowledge of the insurance industry and can use their skills to help senior citizens receive the best insurance plans for their lifestyles. The insurance professionals at American Senior Benefits put customer satisfaction first, making them a leader in senior insurance coverages.

How Do I Learn More?

To learn more about employer-sponsored Medicare programs, contact the experts at American Senior Benefits. Our licensed experts will be happy to answer any questions you have.

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