A Benefits Pro’s Complete Guide to Medicare

An older couple looks at their smartphone outside

As a benefits pro, you’re probably already intimately familiar with all of the healthcare options your organization offers. (Let’s face it…maybe you even know a little too much.)

When our job is to provide healthcare users with the best possible information so that they can make more informed decisions, we spend all day thinking about how we can better educate folks. But recently, our team here at Jellyvision has realized that there might just be a gap in most benefits education strategies—and that’s Medicare.

Employers don’t tend to focus much on Medicare when it comes to benefits education. After all, it’s traditionally been a service that retired Americans use. By the time they enroll, they’re not employees at your company anymore. Insurance brokers and carriers tend to spend a bit more time on this important healthcare option, but it’s still only a slice of the pie when it comes to their overall priorities.

But today, older employees are putting off retirement and staying at work longer. That means there’s a growing need for benefits providers to improve their knowledge of the Medicare system, so that they can properly inform the aging workforce when the time comes.

Understanding Medicare’s ins and outs can be a daunting task, but we have you covered. In this guide, we’re sharing information you need to know about Medicare to help eligible folks make smarter choices.

A Look at the Current State of Medicare: An Explainer for Benefits Pros

You might already know everything there is to know about how Medicare works and who’s eligible. But what are the latest trends when it comes to this government-sponsored program? Is enrollment on the rise? Who’s most likely to use it?

We have the answers here.

From a general overview of the different types of coverage to recent trends, here’s a look at the current state of Medicare.

What Does Medicare Cover? A Guide for Benefits Pros to Share with Eligible Beneficiaries

When someone invests in health insurance, they want to know that their specific needs will be covered. And as a benefits pro, it’s your job to help them answer questions about which medical procedures, services, and prescriptions are covered under Medicare. 

So we’ve put together a guide of what’s covered (and not covered) under the Medicare umbrella, helping to answer questions like: 

  • What does Medicare consider “medically necessary?”
  • What does Medicare consider “preventive services?”
  • Does Medicare cover dental care? Eye exams? Hearing aids? Chiropractic services?

Learn more about what Medicare covers.

How Benefits Pros Can Help Employees Apply for Medicare

If you work with employees who are nearing retirement age, they’ll probably have questions about when and how to apply for Medicare. And while they’re still in the workforce, it’s your job as a benefits pro to help them feel informed when it comes to choosing and enrolling in the right plans. 

So arm yourself with answers to their most pressing questions, like: 

  • Who qualifies for Medicare?
  • Where do I apply for Medicare? 
  • When should I apply for Medicare? 
  • When does coverage start? 
  • How does Medicare work with employer health plans?

Here’s a detailed overview of how to help employees apply for Medicare.

Comparing Medicare and Medicaid: How to Explain the Difference to Eligible Folks

Medicare and Medicaid: they sound the same, right? They only differ by two letters! Both are government programs. Both are administered by the Centers for Medicare & Medicaid Services (CMS). And both help people pay for health care. So, it’s not surprising that people have a hard time telling them apart.

But that’s about where the similarities end. They’re actually completely different programs, that serve unique populations and offer their own healthcare services.

So, what is the difference between Medicare and Medicaid? Let’s take a closer look, so that you can explain it to eligible beneficiaries.

How Much Does Medicare Cost? Helping Beneficiaries Break It Down

Almost 1 in 5 Americans are covered by Medicare. But the average understanding of how it works, how to use it, and how to pay for it is…underwhelming at best.

That means the aging workforce is likely confused about how much they’ll owe on healthcare this year—all while inflation soars, the cost of living rises, and wages are stagnant. Not exactly ideal, huh? 

Let’s explore how much Medicare costs, part by part, and how to help beneficiaries understand their payment options. (Lots of numbers ahead—don’t get too cross-eyed!)

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

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, their medical needs change, too. They’re more likely to need new services like home health care, skilled nursing, and physical and occupational therapy. And as they think about transitioning from their employer-sponsored health plan to Medicare, they’ll want to know that these new medical needs are covered. 

So let’s take a look at some of the most common questions eligible folks have about Medicare when it comes to aging specifically, like: 

  • Does Medicare pay for assisted living?
  • Does Medicare cover nursing homes? 
  • Does Medicare cover home health care?
  • Does Medicare cover hospice? 

Get the full list of questions and answers about aging and Medicare here.

Medicare and Taxes: Everything Employees Should Know

You know what they say—the only certainties in life are death and taxes. But when it comes to actually understanding taxes and how they impact healthcare spending? Things get…well, a lot less certain. 

Healthcare expenses are a significant burden for Americans, especially as they get older and need more medical attention. And Medicare is a valuable resource for aging folks as they look for ways to save. But how do taxes play a role in funding this government-sponsored healthcare option? 

Let’s explore what employees should know about Medicare and taxes, including how Medicare is funded, who pays for it, and how employees can plan for Medicare-related expenses as they approach retirement.

What is the “Donut Hole” in Medicare?

No, it’s not a treat you can pick up from Dunkin’. 🍩 (We wish.) 

The “donut hole,” also known as the coverage gap, is a temporary limit on how much Medicare will pay in prescription drug coverage under Part D

The donut hole happens when a Medicare user has reached their initial coverage limit but before they have spent enough on their prescriptions to reach what’s called a “catastrophic coverage threshold.”

We know…one more complication in the ever-confusing world of Medicare. Here’s a more detailed rundown of what the donut hole in Medicare is, and how you can explain it to beneficiaries.

There’s a better way to navigate the Medicare maze

As the workforce continues to age, Medicare will become increasingly important for many employees. As a benefits professional, it’s vital to stay up-to-date on changes to the program and communicate these updates to eligible folks regularly. By doing so, you can help beneficiaries navigate the complexities of Medicare, ensuring they have access to the best healthcare options available.

But we know you’re also short on time, and overhauling your Medicare education strategies might not be at the top of your to-do list. That’s where Jellyvision can help.  

ALEX Medicare asks important health questions to help beneficiaries navigate their Medicare options. Available via ALEX Benefits Counselor or ALEX Go, Medicare-eligible folks can access information wherever they are, on whatever device they’re most comfortable using. 

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Find out how ALEX can help eligible folks navigate the Medicare maze.

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