Misunderstood and Underutilized: Medicare Advantage Plans as an Option to Employer-Based Coverage

Matt Miklos October 19, 2023

Matt Miklos of UROne Benefits®explains why and how Medicare Advantage Plans may benefit employees and employers alike.

One of the more confusing and complicated decisions an employee has to make is what to do when they or their spouse turn 65 and become Medicare eligible…especially if they choose to continue to work. And greater numbers of employees aged 65 and older are doing just that.

Understanding Your Aging Workforce

According to the U.S. Bureau of Labor Statistics (BLS), “the labor force participation rate is expected to increase the fastest for the oldest segments of the population-most notably people ages 65 to 74 and 75 and older-through 2024. In contrast, participation rates for most other age groups in the labor force aren’t projected to change between now and 2024.”

ERISA law currently allows individuals working for an employer with more than 20 workers to waive enrollment in Medicare Part A and Part B upon turning 65 and maintain employer-based health insurance as primary coverage.

Due to lack of information and confusion, most of these same employees are not aware they have the option to enroll in Medicare Part A and Part B and choose a Medicare Advantage Plan as their “primary insurance” in lieu of the employer health insurance plan.

This lack of knowledge prevents many Medicare eligible employees from comparing their current participation cost in the form of payroll deductions and out of pocket costs associated with their employer-based health insurance to the cost (or lower cost) and extra benefits available with a Medicare Advantage Plan.

But understanding and educating yourself and employees is a major investment of time and available resources. Yet, the employer that values its employees should provide the necessary support at this juncture of an employee’s work-based and personal life.

However, there’s a solution… Instead of your employees having to do the Medicare research themselves, show them you care by making available cost-free, personal consultation services.

This protects them from the number of government or carrier-based Medicare sites available designed to sell a specific Medicare plan or product leaving many individuals more frustrated, confused, and overwhelmed.

Why is Medicare Advantage good for your employee?

“You’ve already invested in giving your employees access to insurance advisors and trusted advice,” reminds Nicki Miklos, vice president and practice leader at UROne Benefits®.

“As an extension of those services, UROne Benefits® provides customized health and Medicare health insurance options and solutions one person at a time, taking the time to understand every detail — each medication taken by name, dosage and number of times taken per day, important doctor and hospital relationships and other personal needs. Our job is to ensure each employee has the best plan and best cost information available to make the best decision regarding their personal health insurance,” concluded Miklos.

Employees can benefit from plans that require low or zero monthly premium cost, no deductible and manageable co-pay. Coverage can even include prescription drugs, dental services, glasses, hearing aids, meal and transportation services, over-the-counter items like vitamins, toothpaste, low-cost insulin, diabetic products and more, all within the plan at no additional cost.

Once informed, Medicare Advantage Plans are increasingly becoming the eligible employee coverage of choice.

Why is Medicare Advantage good for your organization?

As Medicare-eligible employees become better informed and understand their ability to enroll in a Medicare Advantage Plan as an option to their employer-based health insurance, the employer benefits.

As the workforce ages, associated statistics play a larger role in claim cost projections. Statistically, employees aged 65 and older incur two to three times the claim cost of the average employee aged 40. Claims equal risk and drive health insurance premiums or self-insured costs.

Every employee and/or spouse that chooses to enroll in Medicare and transitions to an Advantage Plan, helps reduce employers’ current monthly premium cost. More importantly, this transition serves to transfer future claim cost associated with an aging workforce, to the Advantage Plan of choice. This transfer of claims can help reduce associated risk, helping to stabilize or reduce factors used to set premium rates or develop self-insured cost projections, benefiting employees and employers alike.

Best of all, this doesn’t strain time or resources when UROne Benefits® acts as your organization’s resource, providing the personal assistance and guidance each employee deserves to make important Medicare insurance decisions.

So, how to get started?

Helping your employees understand Medicare and Advantage Plan options adds to the number of ways the Oswald Companies looks to impact the ever-increasing cost of health care. Providing Medicare education and information to employees that address individual needs and varying Medicare enrollment points in the eligible window of time requires an employer to develop an Aging Workforce Strategy.

Media Center