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Moving to Medicare? Four Facts to Consider

Transitioning from employer-sponsored health coverage (or other private insurance) to Medicare could involve some surprises unless you research the differences in advance. Here are four key facts to get you started.

Medicare does not have an annual out-of-pocket maximum. Most employer health plans cap out-of-pocket expenses during a calendar year. Medicare Part A pays 100% of hospital costs for up to 60 days, after the deductible is met, but there is no limit to copays beyond 60 days. Likewise, there is no limit to the Medicare Part B 20% copay for physician services and outpatient expenses.

Medigap plans, which supplement Parts A and B, may pay for most out-of-pocket costs; Part C Medicare Advantage plans, which replace Parts A and B (and may also include prescription drug coverage), are required by current law to have an annual out-of-pocket maximum. There is no maximum for Medicare Part D prescription drug coverage, but copays are minimal after reaching an annual out-of-pocket limit.


Medicare does not include spousal coverage. Spouses can often be covered under a worker’s employer-sponsored health plan, but each spouse must have his or her own Medicare policy. If a younger spouse is covered under a worker’s employer plan, it may make sense to wait until the younger spouse is eligible for Medicare before the older spouse drops employer coverage.



You cannot contribute to a health savings account (HSA) if you are enrolled in Medicare. Even if you remain covered under a high-deductible health plan at work, you can no longer contribute to an HSA after you enroll in Medicare. Regardless of Medicare enrollment, you can withdraw HSA funds free of federal income tax and penalties to pay qualified health-care expenses, including Medicare premiums. HSA contributions and earnings may or may not be subject to state taxes.

Medicare has late-enrollment penalties. If you have employer-sponsored health coverage and do not enroll in Medicare Parts A and B when first eligible, you can generally avoid penalties if you enroll within the eight-month period that starts the month after the last day of employment or your employer-sponsored health coverage ends (whichever occurs first). A late-enrollment penalty for Part D prescription drug coverage may apply if you go 63 or more consecutive days without having creditable prescription drug coverage. (Most employer plans are considered creditable.)

For additional information, visit Medicare.gov.

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This information is not intended as tax or legal advice, and it may not be relied on for the purpose of avoiding any federal tax penalties. You are encouraged to seek tax or legal advice from an independent professional advisor. The content is derived from sources believed to be accurate. Neither the information presented nor any opinion expressed constitutes a solicitation for the purchase or sale of any security. This material was written and prepared by Broadridge Advisor Solutions. © 2017 Broadridge Investor Communication Solutions, Inc.

THE RETIREMENT PLANNING SPECIALISTS, LLC is a Registered Investment Advisory firm specializing in retirement planning and investment management for individuals committed to a secure financial future. Our objective is to help our clients make educated and informed decisions in order to reduce taxes, increase income, and secure their financial future. If we can be of assistance to you or someone you know, please contact us at the address and phone number below:
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