It is no secret that New York State and County employees have been known to "work for the benefits". It is also no secret that the health insurance for this group of employees is envied by many offering: little to no out-of-pocket cost, superb dental and vision, and minimal denials for a variety of outpatient and inpatient services. Many employees intend to stay with the insurance into retirement and vow to never change carriers. Why would you want to stray, coverage is amazing!!! BUT...all good things must come to an end.

In my line of work, I often hear the line "...it always paid so well" when speaking with retired state and county employees. So how does one go from "working for the benefits" to questioning the benefits? The short answer is that, at age 65, coverage shifts from a primary commercial employer based plan to a Medicare primary plan. Which means the rules change to be compliant with Medicare.

Please note that I am in no way saying that this shift will result in horrible coverage. Your retirement options as a retired state or county employee in New York are ample and there are certain to be some great combinations. BUT, don't fool yourself into thinking that because it worked before it will work the same now OR that it will work better than a non-retirement plan. My professional opinion is to compare the cost and coverage of retirement insurance benefits to that of non-retirement Medicare plans.

There is no way for me to summarize all the different plans and outcomes as these will be unique to each county, region and fiscal year. I will, however, share some lessons learned by other fellow state and county employees.

Lesson One:

A prior client had selected Original Medicare with an Empire BCBS secondary as his retirement insurance plan. As part of his retirement package he was reimbursed the insurance premium by his prior employer. He received a bill for copays for rehabilitation services and called me to ask why, 5-years earlier he had received the same service and had $0 out-of-pocket (he was not on Medicare at that time). I advised him that the Empire plan in his region did no pay for rehabilitation when Medicare pays first. I did suggest that he look into a supplemental plan that would pay secondary to Medicare for the same service. It costs slightly more but he would ultimately pay less year end because the out-of-pocket cost would almost be eliminated.

It is important to note that if he terminated his retirement plan he would not be able to return to it in the future and might forgo premium reimbursement from his employer. It was decided that before making any changes that he speak with HR regarding if he could be reimbursed for the premium of the new plan. To his surprise, this request was approved (because it was cheaper than the Empire plan). Win-win.

Lesson: It cannot hurt to compare and ask questions

Lesson Two:

A prior county employee had decided to go with a Medicare Advantage plan through MVP that was being offered at no cost, except the Medicare Part B premium. She was comfortable with MVP because it was the insurance that she had prior to turning 65. She called me to inquire about why her plan was denying coverage for services provided at the same doctor's office she had always used. After review it was discovered that her provider was not in contract with MVP Medicare products (only commercial MVP products). She had to wait until open-enrollment to switch to a plan that her provider participated with. Thankfully she had little healthcare needs during this time and did not accrue any bills, but this had the potential to be a financial disaster.

Lesson: Plans do not "behave" the same once you turn 65.

Lesson Three:

The daughter of a beneficiary called me upset that her mom had received a $75,000 hospital bill. Mom, a prior county employee, was enrolled in a Blue Cross Blue Shield plan. This seemed odd to me because there is coverage for hospital stays through Medicare. After review it was learned that the beneficiary had never signed up for Medicare A and had a commercial plan that, once turning 65, only pays when Medicare pays primary.

The retiree was able to negotiate the bill down but was responsible for a large balance that would have been paid for 100% by Medicare. She was able to enroll in Medicare A, however, there was no retro coverage.

Lesson: Retirement plans require that you update your coordination of benefits and sign up for Medicare when you turn 65

The moral of the story is that once you turn 65 the rules change and that requires that you learn the new rules and make new choices based on the rules. Reach out to a Medicare planner in your area to review these changes before making any plan decisions.

As always, I provided these consults at no charge and highly recommend them to avoid any unexpected medical bills.

Email me at: [email protected], call me at 607-661-6911,

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I look forward to speaking with you,

Agent Nancy