BIP Spring 2025

Industry Innovation

A smarter approach to retirement and Medicare Help employees make informed decisions to avoid costly mistakes and optimize their benefits.

Many employees remain unaware of how their earnings trajectory can substantially influence their Medicare costs. With this knowledge gap in mind, group benefit advisors are pivotal in positioning employees for a seamless transition to Medicare. Danielle Roberts, co-founder of Boomer Benefits, underscores the need for strategic foresight. “Decisions made at ages 63 and 64 have direct consequences on what individuals will pay for Medicare at 65 and 66,” she says. “Many pre-retirees fail to anticipate that Medicare carries significant costs and that their income levels dictate pricing. We frequently encounter professionals who, upon realizing their projected expenses, delay retirement to recalibrate their financial plans.” A key consideration is the income-related monthly adjustment amount (IRMAA), which leverages a two-year look-back period to determine Medicare premiums. For instance, if an individual liquidates assets, withdraws from an IRA, or accepts a severance package at 63, their adjusted gross income could artificially inflate their Medicare Part B and D costs at 65. “Today, individuals aging into Medicare in 2024 who had a high income in 2022 might see their Part B premium surge to $628, in contrast to the baseline $185,” Roberts says. Policy shifts and advocacy Beyond financial strategy, ongoing regulatory challenges continue to shape the Medicare landscape. With the Trump administration bringing new leadership to the Department of Health and Human Services and CMS, industry advocates see an opportunity to revisit policies. “New appointees mean new conversations,” Roberts says. “One of our primary objectives is to challenge inefficiencies, such as the 48 hour waiting period for Medicare Advantage enrollments, which seniors overwhelmingly find

frustrating. These measures fail to deter unscrupulous actors yet create unnecessary roadblocks for honest brokers and clients.” Strategic guidance Sandra Ochoa of Vemax Insurance highlights the critical role that pre-retirement decisions play in long-term financial outcomes. “Timing is everything,” she says. “Delaying Part B enrollment, for example, can lead to lifelong penalties. Some individuals prematurely exit employer-sponsored plans without fully assessing whether Medicare is their best option.” While Medicare Advantage plans offer strong benefits in regions like Miami, where competition has driven down

provider networks, hospital affiliations and prescription drug coverage. “High-deductible employer plans may appear costly on the surface, but depending on an individual’s healthcare utilization, they could still provide superior coverage compared to Medicare alternatives,” she says. Given these complexities, Roberts and Ochoa advocate for a collaborative approach among advisors. “Group benefit brokers who lack direct Medicare expertise can create value by forging partnerships with NABIP members who specialize in the space,” Roberts says. “Hosting educational sessions for employees over 55 not only equips them with crucial information but also enhances the broker-client relationship.”

costs, Ochoa stresses the importance of evaluating

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14 bip magazine Spring 2025