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Medicare and employer coverage

By November 4, 2018 February 4th, 2019 No Comments

If you are 65 + (or turning 65 soon) and will have both Medicare and Employer Coverage because you are still actively working, you have a number of things to think through.

You likely have options to keep your employer insurance and Medicare will coordinate with that coverage. You’ll also want to compare the cost of that employer coverage against what it would cost you to roll over to Medicare as your primary insurance.

Doing your research will help you decide on which coverage option is most cost-effective. It can also help you avoid any Medicare late enrollment penalties wherever possible.

Active Employer Coverage

Active employer coverage means you are still actively working, not retired. In this scenario, you have the right to remain on your employer’s group health insurance plan if you choose. Your Medicare benefits can coordinate with that coverage. HOW it coordinates depends on the size of your employer.

It’s important also to state that these same rules apply if your group health coverage is through your spouse’s employer.

Medicare and Employer Coverage – Large Companies 20+ Employees

Medicare is secondary if your employer has more than 20 employees and you are ACTIVELY working (not a retiree or on COBRA). This is called Medicare Secondary Payer. In this scenario, your group plan pays first, then Medicare pays second.

Most active employees with group coverage enroll in Part A because it is premium-free if you have worked at least ten years. Part A can coordinate to lower your costs if you have a hospital stay. For example, let’s say your employer health plan has a $3000 deductible. The Medicare Part A hospital deductible is $1340 in 2018. So if you have both your employer insurance and Part A, and you incur a bill for a hospital stay, you will only be out $1340. Medicare pays the rest of any Part A services.

One exception would be if you are contributing to an HSA account and plan to continue doing so. If that’s the case, do not enroll in Part A. Read more on that below.

Medicare as Secondary Insurance Costs Money

Now Part B is not premium-free. You will pay a monthly premium for Part B based on your income. Some people eligible for Medicare and employer group health coverage choose to delay enrolling in Medicare Part B and Part D while still covered on their group health coverage (or their spouse’s group health coverage).

This saves them the premiums they would have paid for those parts. Your employer coverage already includes outpatient benefits so it may not be worth it to pay those Part B and D premiums.

When you DO delay Part B, your large group plan is considered creditable coverage. That means that you can enroll in Part B later without late penalty when you decide to retire. Once you quit and leave the group plan, your insurance company will mail you a creditable coverage letter. Be sure you keep this. You will need it to show Medicare that you had other coverage so that you are not subject to late penalties for Parts B and D.

Read more about coordination of your Medicare benefits and large employer coverage here.

What Happens if You Retire and then Later Go Back to Work?

Also, many people ask us what happens if they retire, get Part B, and then later get a new job with employer insurance. You can cancel Part B at that time. Later when you retire again, you’ll have a second 6-month open enrollment window to get a Medigap plan with no health questions asked.

A Word About COBRA

Medicare coordinates differently with COBRA than it does with active coverage. This is important because so many people get this wrong and then owe penalties.

When you are still actively working at a large employer, their Group Insurance pays primary and Medicare pays secondary.

The opposite is true of COBRA. Medicare pays first and COBRA pays second.

So, if you are under 65 and on COBRA, then when you turn 65 you must enroll in Part A and B during your Initial Enrollment Period. You need to enroll because Medicare will be your primary coverage and COBRA only pays as secondary. Failure to enroll during your IEP will result in a lifelong penalty. You can keep COBRA if you like and let it pay secondary instead of a Medigap plan. Just be sure you don’t miss enrolling in both Part A and Part B during your Initial Enrollment Period, which begins 3 months before your 65th birthday month and ends 3 months after your 65th birthday month.

If you work past age 65 and then you retire, you must enroll in Part B no later than your 8th month on COBRA insurance, even if COBRA continues beyond that. Failure to do so can result in a permanent late enrollment penalty for Part B. Even worse, it could delay your Medicare Part B until July of the following year. You do not want to find yourself in a situation where you have to wait months to buy Part B.

The Option to Choose Medicare as your Primary Insurance

People will large group employer insurance also have another option. You can leave your group health plan and choose Medicare as your primary insurance, and then add a Medigap plan. This can often be cheaper for you or your spouse. For many people, it will also reduce your deductible spending and eliminate all doctor copays.

Whether this is cost-effective depends on how much your employer coverage costs you each month in your payroll deductions. Your plan deductible, copays and your medication usage also are factors. If you are married and one spouse is younger, you must also consider the cost of health insurance for the spouse of the Medicare recipient.

Your Boomer Benefits agent can help you decide if you should enroll in Part B now or later. We often meet people that we advise staying with their group plan for now if that makes more sense.

You can investigate more about your options for Medigap or Medicare Advantage plans here.