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Life & Health Insurance/Employer Coverage vs Medicare for Wife


Hi John,
I am 52 with children who are 20 and 22. My second wife is older than me. She turned 65 last August in 2015. We are all on my employer's health insurance that has a $5,000 family deductible, and a $3,300 Flex Spend Debit Card. The plan is a 60/40 after deductible is reached.

The question is about my wife and Medicare. As I recall, hospitalization coverage is mandatory, even though I don't know how or when it would pay if my wife needed it. But also, would my wife be best served if I removed her from my employer's plan and let her be on Medicare alone with medical and drugs?



Let me first say that rules regarding Employer Coverage/Medicare coverage vary state by state, so I would certainly consult a broker in your area that is more familiar with your state's rules. That being said, Medicare Part A and Part B are offered to most. Part A is the hospital coverage that does provide the hospitalization benefit. This typically does not have a premium attached to it (hence, the "entitlement" aspect). Part B usually has a premium ($104.90 in 2015), and this covers doctors visits and charges. There is a deductible you have to meet also. The Part B premium is taken out of your social security check each month.

Since Part A and Part B do not provide adequate coverage for most, there are supplementary plans available through private insurers to help cover some of the remaining costs, and in many cases, the entire cost of services. These are called Medicare Advantage or Medicare Supplements (Part C). I HIGHLY recommend looking at supplements or Advantage plans if you decide to go with Medicare only. She will also need to enroll in a Part D plan, which is the drug coverage.

Altogether, the total costs usually come out to the following..

Part A - No charge
Part B - $104.90
Part C - $125-$150/month or $50-$100/month if through an Advantage plan
Part D - $50/month

I would compare the costs between the employer plan and supplements/advantage plans using a broker in your area to determine the right scenario. Most people tend to move to Medicare from the employers plan because it's less expensive and offers better coverage more times than not. However, that's not always the case.

Hope this helps! Good luck


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John Claborn


Any question on individual or employee-sponsored health insurance, Term life insurance, or Medicare questions. I cannot answer any question involving investment funded life insurance or any government-sponsored entitlement question that does not involve a private insurance company.


Our agency has over 35 years of combined experience. I, personally have been in the insurance business for 6 years. I have dealt with every type of client out there, young and old.

Texas Association of Health Underwriters Lubbock Association of Health Underwriters - Media/Communications Chair Young Professionals of Greater Lubbock Premier Networkers of Greater Lubbock (President)

Bachelor of Arts in Economics from Texas Tech University. Associates of Arts in Business Administration from Frank Phillips College.

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