Insurance Questions

Medicare can be confusing. A licensed Medicare broker helps simplify the process and guide you through your options.

Benefits of Working With a Broker

• Personalized plan comparisons
• Help understanding Medicare rules and timelines
• Assistance with enrollment paperwork
• Access to multiple insurance carriers
• Annual plan reviews as your needs change
• Ongoing support after enrollment

A broker can help you avoid common mistakes such as:

• Missing enrollment deadlines
• Choosing the wrong drug coverage
• Selecting a plan that doesn’t include your doctors or prescriptions

Best of all, there is typically no additional cost to use a Medicare broker.

Medicare is divided into different parts that each cover different healthcare services.

Medicare Part A
Part A helps cover:

• Hospital stays
• Skilled nursing facility care
• Hospice care
• Some home health services

Many people receive Part A premium-free if they paid Medicare taxes while working.

Medicare Part B
Part B helps cover:

• Doctor visits
• Outpatient care
• Preventive services
• Lab work
• Durable medical equipment

Part B has a monthly premium that most beneficiaries pay.

Medicare Part D
Part D provides prescription drug coverage through private insurance companies approved by Medicare.

Part D plans help cover:

• Generic medications
• Brand-name prescriptions
• Many common retail pharmacy drugs

Each Part D plan has its own:

• Drug formulary
• Pharmacy network
• Premiums and copays

Reviewing drug coverage annually is important because formularies and costs can change each year.

Medicare Advantage and Medicare Supplement plans are two very different ways to receive your Medicare benefits.

Medicare Advantage (Part C)
Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans combine your hospital and medical coverage into one plan and often include prescription drug coverage, dental, vision, hearing, fitness benefits, and more.

Key features:

• Usually lower monthly premiums
• Copays and networks typically apply
• May require referrals for specialists
• Often includes extra benefits not covered by Original Medicare
• Annual out-of-pocket maximum protection

Medicare Advantage may be a good fit for people who:

• Prefer lower upfront costs
• Want bundled coverage
• Are comfortable using provider networks

Medicare Supplement (Medigap)
Medicare Supplement plans work alongside Original Medicare and help pay many of the out-of-pocket costs that Medicare does not cover, such as deductibles, copays, and coinsurance.

Key features:

• Generally higher monthly premiums
• Very little out-of-pocket cost when receiving care
• Freedom to see any doctor nationwide that accepts Medicare
• Prescription drug coverage is purchased separately through a Part D plan

Medicare Supplement plans may be a good fit for people who:

• Travel frequently
• Want predictable medical costs
• Prefer maximum provider flexibility

There is no one-size-fits-all answer. The best option depends on your health needs, budget, travel habits, and personal preferences.

Most people become eligible for Medicare when they turn 65.

You can start the process during your Initial Enrollment Period, which begins:

• 3 months before your 65th birthday month
• Includes your birthday month
• Ends 3 months after your birthday month

If You Are Already Receiving Social Security
In many cases, you may be automatically enrolled in:

• Medicare Part A
• Medicare Part B

You’ll typically receive your Medicare card by mail.

If You Are Not Receiving Social Security
You will usually need to enroll yourself through the Social Security Administration.

After enrolling in Medicare, you can then choose:

• A Medicare Advantage plan, or
• A Medicare Supplement plan with a Part D prescription drug plan

Working with a licensed Medicare broker can help simplify this process and ensure you understand your options.

It depends on the size of your employer and the type of coverage you have.

If You Work for a Large Employer (20+ Employees)
You may be able to delay Medicare Part B without penalty while keeping your employer coverage.

Many people in this situation:

• Take Part A at 65
• Delay Part B
• Stay on their group health plan

However, if you contribute to a Health Savings Account (HSA), enrolling in any part of Medicare can affect your HSA eligibility.

If You Work for a Small Employer (Fewer Than 20 Employees)
Medicare may become your primary insurance at age 65. In many cases, delaying Medicare could create coverage gaps or penalties.

Important: Every employer plan is different. Before making a decision, it’s important to:

• Verify how your group plan coordinates with Medicare
• Confirm prescription coverage creditability
• Understand any HSA implications

A Medicare consultation can help prevent costly enrollment mistakes.

Once you enroll in any part of Medicare, you generally can no longer contribute to a Health Savings Account (HSA).

This includes enrollment in:

• Medicare Part A
• Medicare Part B

Important HSA Rules

• You may continue using existing HSA funds after enrolling in Medicare
• HSA money can still be used tax-free for qualified medical expenses

HSA funds can help pay for:

• Medicare premiums
• Copays
• Deductibles
• Prescription costs

Important Timing Issue
If you enroll in Medicare after age 65, Medicare Part A may be backdated up to 6 months. Because of this:

• Many people stop HSA contributions at least 6 months before enrolling in Medicare

Improper HSA contributions after Medicare enrollment can create IRS tax penalties.

IRMAA stands for Income-Related Monthly Adjustment Amount. It is an additional premium some higher-income Medicare beneficiaries pay for:

• Medicare Part B
• Medicare Part D

IRMAA is based on your income from approximately two years prior.

Common Life Events That May Reduce IRMAA
You may be able to request a reconsideration if your income dropped due to:

• Retirement
• Marriage
• Divorce
• Death of a spouse
• Loss of pension income
• Reduction in work hours

How to Appeal IRMAA
You can file:

• Form SSA-44 through the Social Security Administration.

Supporting documentation is often required. Many people successfully reduce or eliminate IRMAA after retirement or other qualifying life events.

A health insurance broker helps employers compare options, understand costs, and build a benefits package that aligns with their budget and workforce needs. Brokers serve as advisors throughout the year, not just during enrollment.

A Broker Can Help With:

• Comparing plans from multiple insurance carriers
• Evaluating group and individual-based solutions
• Explaining plan designs and cost-sharing structures
• Managing enrollments and employee communications
• Assisting with renewals and plan changes
• Providing ongoing support for employee questions

Why This Matters:
Working with a broker can save time, reduce confusion, and help ensure you're making informed decisions about one of your company's largest employee expenses.

Today's small businesses have more health benefit options than ever before. The best solution depends on your budget, workforce, and business goals.

Common Options Include:

• Traditional small group health insurance
• Level-funded health plans
• Individual Coverage Health Reimbursement Arrangements (ICHRA)
• Qualified Small Employer HRAs (QSEHRA)
• Dental and vision insurance
• Life and disability insurance
• Voluntary employee-paid benefits

Why This Matters:
Every business is different. Exploring multiple options can help you balance employee satisfaction with long-term affordability.

An Individual Coverage Health Reimbursement Arrangement (ICHRA) allows employers to provide employees with a tax-free allowance to purchase their own individual health insurance coverage.

Benefits of an ICHRA:

• Predictable monthly budgeting for employers
• Employees choose their own plans
• Works well for remote or multi-state workforces
• Flexible contribution amounts
• Potentially lower administrative burden

Why This Matters:
An ICHRA can provide employees with choice while giving employers greater control over healthcare spending.

A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) allows eligible small employers to reimburse employees for health insurance premiums and qualified medical expenses on a tax-advantaged basis.

QSEHRA Features:

• Available to eligible small employers
• Employer-funded reimbursement arrangement
• Annual contribution limits set by the IRS
• Employees can use reimbursements for qualified expenses
• Alternative to traditional group health plans

Why This Matters:
QSEHRAs can provide flexibility and cost control for smaller employers that want to help employees with healthcare expenses.

The cost of group health insurance depends on several factors, including employee demographics, location, plan design, and employer contributions.

Factors That Affect Cost:

• Employee ages
• Number of enrolled employees
• Geographic location
• Plan deductible and out-of-pocket limits
• Employer contribution strategy
• Type of plan selected

Why This Matters:
Understanding all available options—not just traditional group plans—can often uncover opportunities to reduce costs while maintaining valuable benefits.

Eligibility requirements vary by state and insurance carrier, but many small businesses can qualify for coverage with as few as one eligible employee.

Eligibility Factors May Include:

• Business structure
• Number of employees
• State regulations
• Participation requirements
• Employer contribution requirements

Why This Matters:
Many small business owners assume they are too small to offer benefits when they may actually have several available options.

Yes. Many benefit solutions are designed specifically for companies with remote employees located in different cities or states.

Popular Solutions for Remote Teams:

• ICHRA programs
• National PPO networks
• Multi-state group plans
• Dental and vision benefits
• Supplemental coverage options

Why This Matters:
Offering benefits can help remote employers attract and retain quality employees regardless of location.

Many small employers are not legally required to offer health insurance, but doing so can provide significant business advantages.

Potential Benefits of Offering Coverage:

• Improved employee retention
• Stronger recruiting position
• Enhanced employee satisfaction
• Potential tax advantages
• More competitive benefits package

Why This Matters:
Health benefits are often one of the most valued employee benefits and can play a major role in workforce stability.

Yes. Many employers choose to offer dental and vision coverage as standalone benefits or alongside a medical plan.

Common Ancillary Benefits:

• Dental insurance
• Vision insurance
• Life insurance
• Disability insurance
• Accident coverage
• Critical illness coverage

Why This Matters:
Ancillary benefits can provide meaningful value to employees while often being more affordable than major medical coverage.

Both approaches can be effective, but the best fit depends on your workforce, budget, and long-term goals.

A Traditional Group Plan May Be Better If:

• Employees prefer a single company-sponsored plan
• Most employees are located in the same area
• You want a more traditional benefits structure

An ICHRA May Be Better If:

• You have remote employees
• You want predictable healthcare costs
• Employees value plan choice and flexibility

Why This Matters:
Comparing both options side-by-side can help identify the most cost-effective and employee-friendly solution.

Benefits are often a key factor in attracting and retaining quality employees. A well-designed benefits package can strengthen your company and improve employee satisfaction.

Benefits Can Help:

• Recruit top talent
• Reduce employee turnover
• Improve morale and productivity
• Increase employee loyalty
• Create a competitive advantage

Why This Matters:
Investing in employee benefits is often an investment in the long-term success and stability of your business.

The first step is evaluating your workforce, budget, and business goals. A benefits consultation can help identify the solutions that best fit your company.

Information Typically Needed:

• Business location
• Number of employees
• Employee census information
• Current benefits (if any)
• Budget considerations
• Coverage objectives

Why This Matters:
Starting with a clear strategy can help you avoid unnecessary costs while providing meaningful benefits to your employees.