Compliant Conversation with T65 Spouse on Group

[yorkriver1]

Any pitfalls in talking to the EE and spouse about going on a MedSupp? I feel an obligation now to be sure the spouse enrolled in Medicare A, to avoid/minimize the late penalty, and talk about B, etc.

It's time for open enrollment plan shopping, and self funded looks interesting.
There is this sense I have that I want to help, but also a little bit, too, of wanting to drive down the averaged composite rates for the group. Spouse turned 65 6 months ago, and is paying at least 2 X what a Medicare supplement, Medicare B and a drug plan would cost. Only drawback is if there are super expensive drugs the health plan is covering. Will need to run RX check for costs on Medicare D to see. If it's to help them, OK, but if seen as manipulating to push spouse off the plan when not necessarily in their best interest--that is what I want to avoid.

 

[Akycha Ron]

"Manipulating" to entice someone to drop coverage would be very bad. There is nothing wrong, in my view" in educating employees as to what their options are. Especially if they are paying any part of the premium.

 

[yorkriver1]

"Manipulating" to entice someone to drop coverage would be very bad. There is nothing wrong, in my view" in educating employees as to what their options are. Especially if they are paying any part of the premium.

The employees pay for all costs other than 50% of EE. Thanks for your response. If I keep in mind I will do the best with the current plan enrollment, the plan choices are up to the employer, and with self funded, the rates based on who is enrolling. Regardless, the Medicare eligible spouse's savings should be offered, without a pushy agenda. One factor I have encountered is the households where spouses have separate bank accounts. The Medicare spouse will work to keep on the group, even if it costs more, irrational for the overall household, but more pocket money short term. I had an individual client who did that.

 

[kgmom219]

Assuming the group has more than 20ee's, the email looks like this:

Dear Bob,

I am doing the annual review of the McDonald's plan and the census shows that your wife is over 65. In some cases, it is significantly less expensive for a person covered under a group plan to move to Medicare and a Supplement. Would you be available for a 5-10 minute phone conversation to discuss further?

Thanks!
York

(cc your contact at the company)

Then you talk to him, explain Medicare, tell him its $122 for Part B and if he will get you her drug list, you can figure out which way is most cost effective. Do a quick spreadsheet and send it to him. Part B, Plan G and Part D is $275ish with copays. Part B and a MAPD is $150ish with copays.

And if you get her moved, great. Her age 65 rates are off the plan and she is saving money.

If you don't get her moved, they know who to call when they finally retire.

And the company is happy, because they know you are trying to lower their costs and provide a service to their employees.

Explaining to a client that they are going to save thousands a year by moving (if they are on cheap generics and paying $500/month) is not unethical.

 

[yorkriver1]

Assuming the group has more than 20ee's, the email looks like this: Dear Bob, I am doing the annual review of the McDonald's plan and the census shows that your wife is over 65. In some cases, it is significantly less expensive for a person covered under a group plan to move to Medicare and a Supplement. Would you be available for a 5-10 minute phone conversation to discuss further? Thanks! York (cc your contact at the company) Then you talk to him, explain Medicare, tell him its $122 for Part B and if he will get you her drug list, you can figure out which way is most cost effective. Do a quick spreadsheet and send it to him. Part B, Plan G and Part D is $275ish with copays. Part B and a MAPD is $150ish with copays. And if you get her moved, great. Her age 65 rates are off the plan and she is saving money. If you don't get her moved, they know who to call when they finally retire. And the company is happy, because they know you are trying to lower their costs and provide a service to their employees. Explaining to a client that they are going to save thousands a year by moving (if they are on cheap generics and paying $500/month) is not unethical.

This! Love the procedure. I had already told the Admin I would call the EE, who I have talked to over the years. Call went well yesterday. Very excited. Going to share with spouse. This method you suggest with actual # estimates is great, documents the up front and non agenda based offer, covers MAPD, covers that comps will be done to see if it does work best. and is proactive, before they go web searching. EE did not realize how much the spouse coverage was taking out of the paycheck. Also didn't know if spouse waived Part B or not. If not, just adds to the savings vs current situation, Checked to confirm if spouse is receiving SS--so didn't have to enroll self in Medicare. Yes, is receiving monthly SS--whew, since the 3 months after T65 is past. No late enrollment penalty.