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Things to Consider When You Are Eligible for Medicare and You Have Employer-Provided Health Care Coverage

Posted by Pekin Insurance on Dec 22, 2014

Many people become eligible for Medicare coverage while they are working full-time and have employer-provided health insurance coverage. The question often arises—how will my group health plan coordinate with Medicare? The answer is found in the plan document provided by your employer. You should read your group health plan carefully when determining which Medicare benefits are best for you.

Some group health plans will automatically adjust the amount of benefits paid on a claim to reflect what Medicare would have paid on the claim. If you do not sign up for Medicare, you can be responsible for that amount. For example, let’s say a claim is $100 and Medicare would normally pay $80, leaving you with a $20 balance. The group health plan may pay the additional $20 that was not covered by Medicare. If you did not sign up for Medicare when you were eligible, the health plan might not pay the $80 that Medicare would have paid, leaving you responsible for $80. In this case, it is in the best interest of patients to have the Medicare coverage, even though they also have group health coverage.

A Medicare Supplement policy is another option when you become eligible for Medicare. There are different Medicare Supplement plans. You can choose a plan that will cover the Medicare deductibles and coinsurance amounts. It would be wise to compare the cost of a Medicare Supplement policy, to the cost of your employer’s health plan. Group health plan coverage may not pay the same way a supplement would. The group health plan may be considered secondary, not a supplement. With secondary coverage, you may still be responsible for deductibles and coinsurance amounts. Your group health plan will explain how it coordinates with Medicare so you can determine which options are best for you.

The website Medicare.gov is a good source of information to find out which Medicare benefits are available to you. An insurance agent may assist you with information about Medicare Supplement policy. Also, compare the cost and coverage of your employer’s health plan to Medicare Supplement policies to help you make the best-informed decision.

Client Support Supervisor


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