Medicare: A Few Things To Consider Before Retirement


You’re turning 65 and starting to ask some very important questions about how your health insurance coverage is going to change in the near future. Depending on your situation you may have questions of whether you should continue your employer coverage, wait until your spouse also turns 65 to make the switch, or if you’re celebrating your birthday in close proximity to your spouse – do you need to have the same Medicare plan?

Every once in a while we meet someone that has such amazing employer coverage that it makes the decision to retire extremely difficult -this is certainly the exception, not the rule. In most cases we come across folks that really want to retire, but because of certain medications they take, they have to choose between stepping into retirement and being able to afford their meds. Even group plans that aren’t so great typically do one thing well, which is to cover medications. If you find yourself in this situation, here are a few questions to ask your doctor, the drug company and possibly the insurer themselves: 

  1. Is this medication absolutely necessary? As a general rule, if the medicine you’re taking has a commercial on prime time T.V. it’s going to be expensive with Medicare. Discussing whether or not that drug is necessary with your doctor is a good place to start. 
  2. Is there a generic available? Again, if the drug in question is brand new this won’t be on the table, but at times there are some tried and true options that may work just as well for you, and save you money. 
  3. Does the drug manufacturer offer assistance to pay for the medication? There are quite a few instances where the drug company will actually subsidize the cost of your medications. In this situation, it’s important to contact them A.S.A.P. to find out what the guidelines are to get assistance, if possible. 
  4. Can the insurance company provide a formulary exception? Sometimes staying on your group plan isn’t an option. If the drug you’re taking is new, and it cannot be substituted for, the high cost of the drug may be due to the fact that the insurance company has not yet made it  part of their formulary. In this case, reaching out to the insurer and requesting a formulary exception may help. It’s also possible that this option in conjunction with assistance from the manufacturer could cover the majority of the cost associated with your medication.   

For those if you that are married, this one’s a biggie – what about my spouse’s insurance? If you currently carry insurance for the two of you, and there’s a significant gap in time between when you both reach 65, you might be anguishing over the fact that you’re going to have to work longer than you wanted. Private insurance can be expensive, so it’s important to have a good idea of what you’ve been paying to see whether it makes good financial sense to make the move. If this is where you find yourself, these are our top 2 options:

  1. Check out the Marketplace. Although Medicare is where we specialize, as we saw a growing need for spouses to make sure their significant other maintained coverage after they turned 65, we started helping out with this process. Now… to be perfectly honest, some of these plans are not the greatest, but it is a viable option to bide some time. There are lots of plans to choose from, and most people can qualify for a subsidy that will help to offset the cost.
  2. Short term coverage. This is a great option if you are in relatively good health and don’t have long to wait before turning 65. It’s important to note that these plans do not cover preexisting conditions, but are a great option to have in place if you’re simply doing yearly health visits and protecting against something catastrophic. 

One of the biggest differences you will find when switching over to Medicare is that each plan is designed for an individual. Gone are the days of having a handful of plans to choose from that will cover both you and your spouse. Once you begin Medicare each of you will be able to select a plan that is best suited for you, even if they’re different. While this can potentially impact what you’re paying for coverage, (because you will now both be paying your part B premiums individually), it also presents a unique opportunity to find coverage that is tailored to fit your specific healthcare and medication needs.

If you have any questions about how making the jump into Medicare will impact you, please reach out to us. Our passion is helping people, like you, make sense of all the variables to ensure that you and your family are covered well.


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