Council on Aging Answers 2017 - 98

COUNCIL ON AGING - SOUTHERN CALIFORNIA

Retiree Health Plan
Benefits vs. Medicare

INSURANCE

n Linda Walton RN, MS
Council on Aging - Southern California

Retiree health plans can vary widely so it is important
to know what benefits your plan provides and how or if
it coordinates with Medicare.
As a general rule, retiree health plans are equal to or
better than Medicare. They offer a broader prescription
drug benefit, and some include vision and dental plans
that are NOT included with Medicare. Retiree health
plans coordinate with Medicare; they are not considered
Medigap plans.
Medicare is your primary coverage; your retiree
benefits pay after Medicare. According to the California Health Advocates, retiree health plans may provide
traditional fee-for-service coverage or will cover you
through a Medicare Advantage plan (HMO / PPO).
These plans require enrollment in Medicare parts A and
B. While called a Medicare Advantage plan, the retiree
health plan will have negotiated benefits that may be
very different from an Advantage plan offered through
Medicare. Some retiree health plans automatically
supplement Medicare benefits, while others may apply
deductibles or not cover expenses traditionally covered
by Medicare.
Questions to consider before making a decision regarding your retiree health plan:
n Does it coordinate with Medicare?
n How do the costs of the plan compare with Medi-

Answers Guide 2017

care costs (premiums, cost-sharing, deductibles?)
n Does it have a "creditable coverage" prescription
drug program?
n Does the retiree plan include dental, vision, and
hearing benefits?
n How does the retiree prescription drug plan compare to a Medicare Part D drug plan?
n Is there coverage for my spouse?
To understand your retirement insurance coverage,
contact your company's Human Resources Benefits Coordinator. Conduct a cost comparison and evaluate the
risks. Learn whom to contact regarding benefit changes
or if you experience payment problems. If you are considering changing your existing retiree plan to Medicare, understand the details. Many retiree plans will not
let you re-enroll if you change to Medicare.
To learn more about Medicare plan benefits, contact
the Council on Aging-Southern California Health Insurance Counseling & Advocacy Program (HICAP) at
(714) 560-0424. Appointments to meet with a HICAP
counselor at no cost are available in most of the senior
community centers in Orange County. Call your local
center and request an appointment with the HICAP
counselor.
HICAP is a no-cost service to help you understand
and maximize your Medicare benefits. Funded in part
by the California Department of Aging, HICAP is the
most dependable source of unbiased, accurate and upto-date Medicare-related information.

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