Medicare And Employer Insurance: What To Know
by Sumona Insurance 09 August 2022
If you’re currently employed and would qualify for Medicare soon, you probably have multiple questions concerning what to do regarding your health care coverage.
Typically, people in the US retire at 66 to 67 years of age. You can qualify for Medicare when you reach 65, and several people at that age may also have an existing group health plan benefits through their employer (that is, if they are still working).
Due to the abovementioned circumstance, you can gain Medicare and a group health plan (your employer has provided) after you move past age 65.
Therefore, for these persons, both Medicare and employer insurance can provide them with the healthcare needs and costs that are covered in their insurance policy.
How Does Medicare Work with Your Employer Insurance?
If you’re already eligible for Medicare and have plans to get one, it is recommended for you to do your research. Start by reading about how to enroll in Medicare and prepare all the necessary documents you might be required to comply with.
Original Medicare (Part A and Part B) can provide comprehensive hospital and medical coverage. This is also the case when it comes to employer health plans.
Thus, it’s crucial to remember that these insurance coverages don’t intend to replace each other. Instead, they can work together to provide for your covered expenses.
Is It Possible To Keep Your Employer Health Plan With Medicare?
Suppose you currently have a health insurance plan from your employer and are also eligible for Medicare. You might be wondering whether to choose Medicare or your group health plan.
If this is the case, it’s crucial to know that in most cases, the company where you work regulates whether you’ll be facing penalties for not enrolling in Medicare when you can qualify.
The following are the rules for sticking to your employer insurance and not enrolling in Medicare even when you can qualify:
- If your employer has less than 20 workers, it’s crucial to sign up for Medicare when you can qualify, or you might receive a late enrollment penalty for Part B if you choose to sign up later.
- If your employer has 20 or more workers, it’s possible to sign up late without getting any late enrollment penalty.
If you have not reached the age of 65 yet but are eligible for Medicare due to a disability, you will not be required to sign up until you reach 65. However, if the company you work for still provides you with group health insurance coverage, the same rules mentioned earlier apply to your situation.
If you choose to retire and discontinue your employer insurance benefits, you’ll be given eight months as a special enrollment period to get original Medicare. This is the case if you haven’t enrolled yet. Moreover, this special enrollment period will begin a month after the group health insurance plan ends.
What Are The Out-Of-Pocket Costs In Choosing Both?
Applying for Medicare isn’t free. You’ll need to pay a monthly premium for medical insurance (Medicare Part B). However, when it comes to hospital insurance (Medicare Part A), you might receive it premium-free.
You can opt to enroll for Medicare Part A first when you can qualify and then sign up for Medicare Part B later when your employer coverage ends. This technique can be a cost-conscious strategy to increase your insurance coverage when you choose to get both Medicare and group health plans from your employer.
It’s critical to know that original Medicare tends to have deductibles, coinsurance costs, and copayments. So, for example, you might have to pay about 20% after you’ve achieved your annual Medicare Part B deductible for the medical supplies and services covered under the same insurance plan.
Other parts of Medicare, such as Part C and D (Medicare Advantage and prescription drug coverage, respectively), might also charge monthly premiums. In addition, you still need to pay for Part B as well if you have one. Furthermore, it’s crucial to know that you must be enrolled in original Medicare before qualifying for the other parts.
When it comes to employer coverage costs, you can easily find them on your paycheck. If you’re satisfied with the coverage, you might want to keep it. Moreover, it’s essential to assess your coinsurance cost-sharing amounts and deductibles from time to be aware of the costs.
Who Pays First?
If you decide to keep your employer insurance coverage and also enroll in Medicare, here are the rules on who pays first:
- If your company has 20 or more employees, the group health plan your employer provides usually pays first. This makes Medicare a secondary payer who pays for the portions of covered services that your employer didn’t pay through the health plan.
- If your company has less than 20 employees, Medicare typically pays first. This means that your employer insurance is now the secondary payer.
To Sum It Up
It’s vital to know that the best choice will entirely depend on your situation. You can opt to get either Medicare or employers insurance or both.
Furthermore, it’s recommended that you understand how Medicare and your employer insurance work first before deciding which coverage perfectly fits you.
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