Medicare and Individual Insurance: What You Need to Know Now

October 5, 2023

The challenge of managing the ever-increasing cost of health insurance has become more difficult as additional factors contribute to the number and frequency of claim occurrences due to an aging workforce and an increase in events that trigger COBRA eligibility.

Employers may not be able to eliminate or control the occurrence of claims. However, employers can implement risk management strategies that help transition or avoid potential claims that drive health insurance premium costs. This strategy requires employee access to information, education and personal assistance regarding affordable options to employer-based coverage.

Take a fresh look below for personal health insurance options (Short-Term, Affordable Care Act (ACA) or Marketplace and Medicare Plans) that can eliminate claims occurrence from:

  • New hires
  • COBRA annuitants
  • Employees working beyond age 65

New Hires

Approximately 75 percent of employers require new hires to complete a waiting period of up to 90 days before health insurance coverage begins, and for good reason. Laws protect individuals from discriminatory hiring practices based on health or pre-existing conditions. At the same time, a growing number of individuals seek employment for access to employer-based health insurance. To balance the needs of the new hire and that of the company, Marketplace and Short-Term plans can be used to bridge the new hire waiting period gap in coverage.

COBRA Annuitants

Employers can inform employees of personal health insurance options to the continuation of coverage under the COBRA law. The Medicare Rights Center reports that individuals and families choosing to pay the monthly premium to maintain extended access to and use of the employer-based plan under COBRA tend to:

  • Be older, 50 years old, than the average age of the full-time covered employee, 42 years old.
  • Use health care more frequently. COBRA claimants had almost five times more hospital days and filled twice as many prescriptions than those covered at work.
  • Have more chronic conditions. People using their rights under the COBRA law are more likely than those working with employer-based coverage to have chronic conditions such as COPD, diabetes, cancer, high blood pressure, high cholesterol, mental health disorders and musculoskeletal disorders.
  • Spend more on health care.

Employees Working Beyond Age 65

For a variety of reasons, more people are choosing to work beyond age 65, maintaining health insurance through their or spouse’s employer. As a result, employee payroll contributions, plan deductibles and out-of-pocket costs continue to increase.

By 2024, the U.S. Bureau of Labor Statistics projects that the labor force will grow to about 164 million, of which 25 percent will be age 55 and older. Employees 65 and older are projected to have a faster rate of annual labor market growth of any other age group…55 percent ages 65 to 74 and 86 percent ages 75 and older. The Kaiser Family Foundation reports that individuals 65 and older are responsible for almost 40 percent of total health spending by age group.

A misunderstood and underused option for the growing number of employees aged 65 and older is to exercise their right to choose Medicare as their primary health insurance in lieu of employer-based coverage. Medicare plans like Medicare Advantage can provide an attractive, personal option, lowering the employee monthly cost of being enrolled in a group health insurance plan, as well as reducing an employee’s out-of-pocket cost. Plans are designed to provide greater levels of coverage and access to benefits like prescription drug, dental, vision, hearing aids, meal and transportation services at no additional cost.

Oswald Companies and UROne Benefits™ provide unmatched access and advisory on the full range of individual health insurance options.

To discuss and implement these important risk management strategies, please contact your Oswald Client Service Team or call UROne Benefits™ at 330-845-4771.