Investing Strategies

Here’s how advisors can help clients avoid common and costly Medicare mistakes

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No two retirements look the same. But there is one thing all individuals face in their golden years: high health-care costs.

Medicare beneficiaries will need as much as $400,000 for health expenses per couple, according to 2018 research from the Employee Benefit Research Institute. That is up from $370,000 in 2017.

Medicare comes with plenty of rules, and if retirees run afoul of them, that could add to those health-care costs for the rest of their lives.

“People do feel overwhelmed and baffled by Medicare,” said Katy Votava, president of “But there are some basic things that an advisor can do.”

Tips for financial advisors

Admittedly, Medicare rules have countless nuances. Unless you have someone on your team devoted to the topic full time, it can be overwhelming to take on.

But there are some ways that financial advisors can help start the conversation with clients, as well as resources to which they can point them.

  • Add health care to your client meeting agenda. “Put it on the annual agenda, and a lot of those issues will fall out before they’re a crisis,” Votava said.
  • Start talking with clients about Medicare as early as age 62. Have them identify which doctors they are seeing and if they will be able to continue to use them once they are on Medicare.
  • Cultivate relationships with local Medicare experts to whom you can refer clients. Start by getting suggestions for unbiased insurance providers from clients who have already gone through the process.

Advisors can also engage in some troubleshooting for a few key situations when clients are most susceptible to making missteps.

Turning 65

Reaching age 65 is a key milestone when it comes to Medicare eligibility.

But exactly what that means is changing, as more individuals continue to work into their 60s.

As a result, many of your clients face the same Medicare question: “Do I have to go in at 65 or don’t I?” according to Votava.

If a client is employed and their employer health plan meets the right criteria, they can delay signing up for Medicare. That is provided they have not started receiving Social Security retirement benefits, which would trigger automatic enrollment at 65 in Medicare Parts A and B, which cover hospital and medical insurance.

In order for your client to be eligible to delay, their employer must have 20 or more employees. The employer plan also cannot be a retiree or COBRA plan, according to Votava. The plan also must meet Medicare prescription drug coverage requirements, she said.

“If you have that coverage … you can delay until a special enrollment period in the future,” Votava said. “If none of those criteria are true, then you need to get into Medicare.”

One thing you’ll want to have still-employed 60-something clients consider: Sometimes Medicare coverage is the better choice over an employer plan, Votava said.

If a client does need to sign up at 65, they do not want to wait, because the penalties are costly.

The initial enrollment period runs from three months before someone’s 65th birthday to three months after.

If your client misses that date and does not have creditable coverage, they will face a 10% surcharge on their premium for every 12 months that they wait, said Katherine Roy, chief retirement strategist at J.P. Morgan Asset Management.

“It could get quite costly if someone has their mind set, ‘Hey, I’m in great shape. I’m not going to insure myself through Medicare, and I’ll just sign up when I need it,'” Roy said. “That is a very costly, bad decision to make.”

COBRA coverage

Once a client leaves their employer, they may have the ability to continue their health coverage through COBRA.

(COBRA is a health insurance program that allows an eligible employee and his or her dependents the continued benefits of health insurance coverage in the case that employee loses his or her job or experiences a reduction of work hours.)

However, sticking with that coverage could be a costly mistake once someone is age 65 and over.

“COBRA is the biggest stumbling block where people are misinformed and stay on it when they shouldn’t,” Votava said.

Votava has seen this situation so often she calls it “being attached to the mother ship.”

“They’re comfortable, and they think it works well,” Votava said.

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The problem is that COBRA is not considered a substitute for Medicare coverage. So if someone gets sick and they should be on Medicare, that is supposed to be their primary insurance. Consequently, COBRA, which is secondary coverage, will only cover 20% of the bill in many cases, Votava said.

“You’re paying a huge amount of money for 20% of coverage,” Votava said. “It just doesn’t work.”

What’s more, staying on COBRA could lead clients to miss their Medicare special enrollment period.

For example, if someone’s 18-month COBRA coverage is up this month, they would have to wait until the first quarter of 2020 to apply for Medicare coverage. Then, their coverage wouldn’t start until July 1, 2020.

Until that coverage starts, they will have to pay 100% of their health-care costs. Then, they will pay more — by up to 10% to 12% — for their Medicare premiums for the rest of their lives, Votava said.

Health savings accounts

Health savings accounts let your clients put away funds toward health-care expenses if they’re covered by a high-deductible health plan.

The money that goes into an HSA is not taxed, nor are any gains on the money that’s invested or withdrawn. Because of that, many people rely on the savings in these accounts to help fund their retirement expenses.

But once someone is on Medicare, they can no longer contribute to an HSA. If they do, they will face a 10% penalty, Roy said.

But the restrictions faced will vary by age. For example, if a client leaves their company at age 65 and starts Medicare coverage as of July 1, they can contribute to an HSA until that date, or half the maximum amount for the year.

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But if they’re 68 and start Medicare as of July 1, it’s retroactive back to January, Roy said. That means that any contribution to an HSA that was made that year will be subject to a penalty, she said.

The good news is that if clients contribute to an HSA while on Medicare, they can correct their error.

“You can back it out and fix it if you know in time,” Roy said.

People have until they file taxes for that year, which means they need to correct their mistake within that year, she said.

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