Aging and Medicare: The Top 10 Questions Beneficiaries Ask Benefits Pros

There’s something strange happening with our workforce right now. Americans are living longer for the first time in recent memory, but birth rates are down. That means there’s a growing aging population in the workplace and fewer young folks in the talent pool.

In fact, by 2035, 16% of the workforce will be 70 or older. That’s about 1 in 6 employees! Talk about a seismic shift. And as folks age, one of their primary concerns is access to healthcare. But HR teams haven’t always offered much guidance for older populations, who had typically retired before they needed resources like Medicare

However, now’s the time to rethink that logic. Employees today will likely need access to Medicare for years before they retire, and they’re looking for support from a trusted advisor. Let’s jump into the top questions benefits pros receive about aging and Medicare so that you feel prepared the next time an employee comes your way. 

1. When am I eligible for Medicare?

Individuals are generally eligible for Medicare at age 65. However, eligibility can vary based on certain disabilities or specific medical conditions. Benefits pros should inform employees approaching retirement age that they’re eligible for Medicare and advise them to apply for coverage.

2. Should I enroll in Medicare if I’m still working?

Employees who are still working and have employer-sponsored health coverage may not need to enroll in Medicare at age 65. In some cases, it may be smart to enroll in Medicare Part A, which covers hospital stays, as it can provide secondary coverage in the event of a catastrophic illness or injury.

Employees who enroll in Medicare may be able to keep their employer-sponsored health coverage, but the coverage may change. It’s important to help employees understand their options and how Medicare pairs with your organization’s employer-sponsored coverage.

Pro Tip: ALEX can help!

ALEX Medicare gets to know employees through a one-on-one conversation and helps them navigate the intricacies of Medicare (without burdening your team). Available via ALEX Benefits Counselor or ALEX Go, aging employees can access guidance wherever they are, on whatever device they’re most comfortable using. 

3. What happens if I don’t enroll in Medicare when I’m eligible?

If employees don’t enroll in Medicare when they’re first eligible, they might face penalties and gaps in coverage. The penalties depend on the type of Medicare coverage an employee is eligible for and when they enroll.

Here’s a breakdown of what can happen if employees don’t enroll in Medicare when they’re eligible:

1. Parts A and B:

If an individual is eligible for Medicare Part A (hospital insurance) and Part B (medical insurance) and doesn’t enroll when they’re first eligible, they may have to pay a late enrollment penalty for Part B. The penalty is a 10% increase in their Part B premium for each full 12-month period that they were eligible for Part B but didn’t enroll. This penalty is permanent and added to their Part B premium for as long as they have Part B (unless they qualify for assistance).

Individuals might also face a gap in coverage if they don’t enroll in Part B and don’t have coverage through another healthcare plan. They’ll need to wait until the next general enrollment period (January 1 to March 31 each year) to enroll in Part B, and their coverage won’t start until the first day of the month after they sign up.

2. Parts C and D

If an individual is eligible for Medicare Advantage (Part C) or Prescription Drug plans (Part D) and doesn’t enroll when they’re first eligible, they may face a late enrollment penalty if they enroll later. The penalty amount and duration depend on the plan and how long they went without coverage.

4. What are the different parts of Medicare, and what do they cover?

Medicare is divided into four parts: Part A, Part B, Part C, and Part D. 

  • Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health care. 
  • Part B covers doctor visits, outpatient care, and medical equipment. 
  • Part C, also known as Medicare Advantage, provides additional benefits beyond Parts A and B and may include prescription drug coverage. 
  • Part D covers prescription drugs.

Learn more about what’s covered under each Medicare bucket.

5. Does Medicare pay for assisted living?

Unfortunately, Medicare generally doesn’t pay for assisted living. Medicare typically covers only medically necessary care, like hospital stays, doctor visits, and some home health care. Assisted living is considered non-medical custodial care, which isn’t covered. 

However, Medicare may cover certain services provided in assisted living facilities, like skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services. For Medicare to cover these services, they must be deemed medically necessary and provided by a healthcare professional.

It’s also worth noting that other programs, like Medicaid, may offer financial help for folks in assisted living facilities. Medicaid is a joint federal-state program that provides healthcare coverage to low-income individuals. Some states offer Medicaid waivers that cover some of the costs associated with assisted living.

6. Does Medicare cover nursing homes? 

Medicare offers limited coverage for nursing home care. Generally, Medicare will only cover care in a nursing home facility for a limited period of time following a hospital stay. This coverage is called the “Medicare Part A Skilled Nursing Facility (SNF) Benefit.”

To be eligible for Medicare coverage in a nursing home, an individual must have been hospitalized for at least three days and admitted to a Medicare-certified SNF within 30 days of their hospital discharge. Medicare will cover up to 100 days of skilled nursing care per benefit period, with certain co-payments after the first 20 days.

It’s important to note that Medicare does not cover long-term care in a nursing home. If an individual requires long-term care in a nursing home for non-medical reasons, such as assistance with activities of daily living (ADLs) like bathing, dressing, and grooming, they may need to pay for these services out of pocket or through other services, like Medicaid.

7. Does Medicare cover home health care?

Yes! Medicare does cover certain types of home health care. Home health care is a range of services that can be provided at home to help employees recover from an illness or injury, manage a chronic condition, or receive palliative care.

Under Medicare, eligible individuals may receive the following home health services:

  1. Skilled nursing care: Services provided by licensed nurses, such as wound care, injections, and medication management.
  1. Physical therapy: Services provided by licensed physical therapists, such as exercises to improve mobility, strength, and balance.
  1. Occupational therapy: Services provided by licensed occupational therapists, such as exercises to improve daily living skills, such as dressing and grooming.
  1. Speech-language pathology: Services provided by licensed speech-language pathologists, such as exercises to improve speech and communication.
  1. Medical social services: Services provided by social workers, such as counseling and assistance with community resources.
  1. Home health aide services: Personal care services provided by certified nursing assistants, such as help with bathing, dressing, and grooming.

To be eligible for home health care under Medicare, an individual must have a doctor’s order, be homebound (meaning it’s difficult for them to leave their home without assistance), and require intermittent skilled care (meaning they need skilled care on a part-time or intermittent basis).

Medicare generally does not cover 24-hour-a-day care at home, meals delivered to the home, or homemaker services (such as cleaning or laundry services). There may also be limits on the amount of home health care services that Medicare will cover.

8. Does Medicare cover hospice?

Yes! If the illness runs its normal course, Medicare covers hospice care for individuals with a terminal illness with a life expectancy of six months or less. Hospice care is intended to provide comfort and support to individuals and their families at the end of life.

Under Medicare, hospice can be provided in the person’s home or in a hospice facility, and may include the following services:

  1. Medical and nursing care: This includes care provided by hospice doctors and nurses to manage symptoms and provide pain relief.
  1. Counseling: This includes counseling provided by social workers and other professionals to help individuals and their families cope with the emotional and spiritual aspects of dying.
  1. Medications: This includes medications needed to manage symptoms related to the terminal illness.
  1. Medical equipment and supplies: This includes equipment and supplies needed to manage symptoms, such as hospital beds, oxygen, and bandages.
  1. Respite care: This includes short-term care provided to the individual in a hospice facility to give their primary caregivers a break.
  1. Bereavement services: This includes support services provided to the family after the individual has passed away.

To be eligible for hospice care under Medicare, an individual must be eligible for Medicare Part A (hospital insurance) and have a doctor’s order for hospice care. They must also have a terminal illness with a life expectancy of six months or less if the illness runs its normal course.

It’s important to note that while receiving hospice care, individuals generally agree to forego curative treatment for their terminal illnesses. Hospice care focuses on providing comfort and support rather than on curing the illness.

9. How much will I pay for Medicare?

The (not so) easy answer? It’s complicated. 

The cost of Medicare varies depending on the specific parts of coverage an individual enrolls in, as well as their income. Most individuals do not pay a premium for Part A, but premiums for Part B, Part C, and Part D vary based on income and other factors. 

Costs also fluctuate year over year, so it’s important to keep employees up to speed on the latest premiums and deductibles. 

Here's a full breakdown of Medicare costs, part by part.

10. Can I change my Medicare coverage?

Yes, beneficiaries can change their Medicare coverage during certain times of the year, known as Medicare enrollment periods.

The Annual Enrollment Period (AEP) is the time when most people can change their Medicare coverage for the next year. The AEP runs from October 15 to December 7 each year. During this time, beneficiaries can switch from Original Medicare to a Medicare Advantage plan, switch from a Medicare Advantage plan back to Original Medicare, or switch from one Medicare Advantage plan to another.

There are also other enrollment periods that may allow users to change their coverage. The Initial Enrollment Period (IEP) is the first time individuals become eligible for Medicare, and beneficiaries can enroll in Medicare Advantage or Prescription Drug plans. 

The Medicare Advantage Open Enrollment Period (OEP) runs from January 1 to March 31, during which time users can switch from one Medicare Advantage plan to another or switch from Medicare Advantage to Original Medicare with or without a Part D drug plan.

It’s important to note that there are certain rules and limitations to changing Medicare coverage, so help eligible folks review their options carefully to understand their choices and the potential impacts of making changes.

Better support for an aging workforce

There’s no denying it: the workforce is older than it used to be. So it’s our job as benefits pros to help employees understand their options when it comes to Medicare enrollment, coverage, and costs.

Benefits providers and HR teams play a crucial role in helping employees make more informed decisions about their healthcare coverage. And by understanding the top questions they ask, we can better support employees as they prepare for retirement. 

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