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

October 19, 2023

Matt Miklos of UROne Benefits™ explains why and how Medicare Advantage Plans may benefit companies and their employees.

One of the more confusing and complicated decisions an employee has to make is what to do when they or their spouse turns 65 and becomes eligible for Medicare, especially if they continue to work.

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 a 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 their employer’s health insurance plan.

This lack of knowledge prevents many Medicare-eligible employees from comparing their current participation cost associated with their employer-based health insurance to the cost and extra benefits available with a Medicare Advantage Plan.

Understanding and educating yourself and employees is a major investment of time and available resources.

Instead of your employees doing the Medicare research themselves, show them you care by making available cost-free, personal consultation services.

This protects them from many government or carrier-based Medicare sites 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?

“By working with UROne Benefits™, you’ve already invested in giving your employees access to insurance experts 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 insurance options and solutions to each individual. We take 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 cost information available to make the right decision regarding their personal health insurance,” concluded Miklos.

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

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 alternative to their employer-based health insurance, the employer benefits.

Statistically, employees aged 65 and older incur two to three times the claim cost of the average 40-year-old employee. Claims equal risk and drive health insurance premiums or self-insured costs higher.

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

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

How to get started

Helping your employees understand Medicare and Advantage Plan options adds to the number of ways UROne can impact the ever-increasing cost of health care. UROne Benefits™ can help you create a strategy that focuses on your employees’ needs and the bottom line. Contact us at 800-722-7331.