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June 12, 2020
Medicare & Employer Coverage
If you or your spouse are still working and receiving health coverage through that employer or union, you may have questions about how your pre-existing healthcare works with Medicare. While it is different for every plan, below are some general tips to help you start to understand your insurance.
How they work
The first thing you should do when trying to understand your pre-existing plan and how it co-exists with Medicare is to contact your employer or union benefits representative. Some employer and union insurance packages cover different parts of Medicare than others.
When you have another insurance company along with Medicare, there are situations in which Medicare will pay first, or the other insurance will pay first. This matters because the insurance company that pays first, referred to as the primary payer, pays up to the limits of its coverage. The secondary payer then pays if there are costs that the primary insurer did not cover. However, the secondary payer may not pay all of the uncovered costs depending on their coverage.
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Who pays first
Generally, Medicare will pay first if:
- You have retiree insurance
- You are 65 or older and have a group health plan based on current employment with an employer than has fewer than 20 employees
- You are under 65, have a disability, and have group health plan coverage based on current employment with an employer that has fewer than 100 employees
- You have Medicaid.
Your other insurance will pay first if:
- You are 65 or older and have a group health plan based on current employment with an employer than has 20 or more employees
- You are under 65, have a disability, and have group health plan coverage based on current employment with an employer that 100 or more employees
- Have ESRD
If you have ESRD, your group health plan will pay first for the first 30 months, and then Medicare will pay first.
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Purchasing Part B and Part D
You must check with your employer or union benefits representative about whether you need to purchase Part B. Some employer insurances will only pay as the secondary payer if you are enrolled in Medicare Part B.
Additionally, some employers will have prescription drug coverage included in their insurance plans. You should check with your employer whether they cover prescription drugs or if you need to purchase Medicare Part D.
We have experience helping people understand their coverage. Contact us to learn more about your benefits.
