Navigating Medicare can feel overwhelming, but it doesn’t have to be. On a recent episode of RHP Market Talk, RHP Wealth Management founding partner and CXO Natalie Picha sat down with Brian Hickey, Vice President at Medicare BackOffice, to unpack the essentials of Medicare planning and how to avoid common (and costly) mistakes.
Brian brings nearly three decades of experience in the insurance industry, with a strong focus on Medicare. His mission? To help people understand their options and make confident, well-informed decisions.
Should I Enroll in Medicare If I’m Still Working?
One of the most common questions Brian hears: “I’m turning 65 next year, but I’m still working and like my employer coverage. Do I still need Medicare?”
The short answer: It depends.
If you’ve already elected Social Security prior to age 65, you’ll be automatically enrolled in Medicare Part A (hospital insurance). Even if you haven’t claimed Social Security yet, you can (and Brian says, often should) apply for Part A—it’s usually premium-free if you’ve worked at least 40 quarters (about 10 years).
Where it gets tricky is Part B (doctor visits and outpatient care), which carries a monthly premium. If you’re still working and have employer health insurance, you can delay Part B without a penalty, but Brian strongly recommends comparing both plans side-by-side. Sometimes, Medicare may actually offer better coverage at a lower cost than your workplace plan.
What Are My Health Coverage Options at 65?
Once you’re eligible for Medicare, you have three primary options:
- Stick with your employer coverage (if available and cost-effective).
- Enroll in Original Medicare only – not recommended due to coverage gaps.
- Enroll in Original Medicare + supplemental coverage, which comes in two main flavors:
Medicare Supplement (Medigap)
- Think of this as ‘paying up front’
- Higher monthly premiums
- No networks – see any provider that accepts Medicare
- No co-pays or coinsurance
- Must buy separate dental, vision, hearing, and drug coverage
Medicare Advantage
- Pay-as-you-go model with co-pays and deductibles
- Often lower premiums (sometimes $0)
- Local provider networks
- Includes bundled extras like dental, vision, hearing, and Part D drug coverage
Brian emphasizes that Medicare Advantage enrollment has surged in recent years, but it’s not right for everyone. Your health status, prescription needs, travel habits, and budget all matter. A neighbor’s plan may not be the best plan for you.
Why Do Zip Codes and Counties Matter?
Here’s something most people don’t realize: Where you live impacts your Medicare options.
- Medicare Supplement premiums are based on your zip code.
- Medicare Advantage availability is determined by your county.
Some insurance carriers offer lower initial premiums to attract new customers, only to raise rates dramatically the following year. That’s why it’s important to choose reputable carriers with a stable rate history.
When Should I Start Planning?
According to Brian, don’t wait until the last minute. Most people should start educating themselves by age 64.
The initial enrollment window lasts seven months: three months before, the month of, and three months after your 65th birthday. Miss it, and you may face a penalty; however, you will be able to enroll during the general enrollment period (January 1 to March 31).
Already enrolled? You should still review your plan annually, especially during the Medicare Open Enrollment Period (October 15 – December 7). Even small changes to your prescriptions or provider network could dramatically alter your costs.
Watch Out for These Common Mistakes
Brian shared some of the biggest missteps he sees:
- Enrolling in Part B when you shouldn’t—or delaying when you shouldn’t.
- Taking advice from friends or neighbors without understanding your own needs.
- Not actively reviewing and managing your coverage on an annual basis, especially as it applies to medication coverage.
What About the Medicare Surcharge?
Higher-income retirees may be surprised by the Medicare Income-Related Monthly Adjustment Amount (IRMAA), a surcharge applied to Parts B and D based on income. While frustrating for savers, Brian reminds clients that the surcharge helps fund the program’s long-term sustainability.
Bottom Line: Medicare Needs a Plan
Whether you're approaching 65, already enrolled, or helping a loved one, Medicare isn't something to figure out on the fly. Like a financial plan, your health coverage should be tailored, reviewed annually, and aligned with your long-term goals.
As Brian puts it: “Medicare used to be set-it-and-forget-it. Not anymore. It needs to be actively managed.”
Need Help Navigating Medicare?
RHP Wealth Management partners with experts like Brian Hickey and Medicare Back Office to guide clients through key transitions like Medicare enrollment. For personalized support or to get in contact with Medicare Back Office, give us a call.