Can I Have Employer Insurance and Medicare at the Same Time?
Medicare is a federal health insurance program that provides coverage for people who are 65 or older, disabled, or have certain medical conditions. Employer coverage is health insurance that you get from your employer or your spouse’s employer. Many people wonder if they can have both Medicare and employer insurance at the same time, and how these two types of insurance work together. In this blog post, we will answer some common questions about Medicare and employer coverage health plan, and help you understand your options and rights.
When Can I Enroll in Medicare Health Insurance?
When you become eligible for Medicare, you can enroll in Medicare Part A and Part B during your initial enrollment period, which is a seven-month period that begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. Part A is hospital insurance that covers inpatient care, skilled nursing facility care, hospice care, and home health care. Part B is medical insurance coverage that covers doctor visits, outpatient services, preventive care, and some medical equipment and supplies.
You can also sign up for Medicare Part A and Part B during the general enrollment period, which is from January 1 to March 31 each year. However, if you enroll during this period, your coverage will start on July 1 of that year, and you may have to pay a late enrollment penalty for Part A and/or Part B.
Another option is to enroll in Medicare Part A and Part B during a special enrollment period, which is a time when you can sign up for Medicare without a penalty if you have a qualifying life event. One of these qualifying life events is losing your employer coverage or your spouse’s employer coverage. You can enroll in Medicare anytime while you have employer coverage or within eight months after your employer coverage or employment ends, whichever comes first.
Do I Need to Enroll in Medicare If I Have Employer health Insurance?
Insurance and Medicare options. If you have employer coverage and you qualify for Medicare, you may choose to delay Medicare enrollment or enroll in Medicare while keeping your employer coverage. The decision depends on several factors, such as the size of your employer, the cost and benefits of your employer plan, and your health care needs.
If your employer has 20 or more employees, your employer group health plan will be the primary insurance or payer for your healthcare costs, and Medicare will be the secondary payer. This means that your employer insurance pays first for the services that are covered by both plans, and then Medicare is the secondary payer , it pays its share of the remaining costs. In this case, you may not need to enroll in Medicare Part B right away, since you may already have adequate coverage from your employer health coverage. However, you may still want to enroll in Medicare Part A if you qualify for it without paying a premium, since it can help cover some of the costs that your employer plan does not cover.
If your employer has fewer than 20 employees, Medicare pays first or will be the primary payer for your health care costs, and your employer health insurance will be the secondary payer. This means that Medicare will pay first for the services that are covered by both plans, and then your employer coverage will pay its share of the remaining costs. In this case, you should enroll in Medicare Part B as soon as you are eligible, since your employer insurance company may not pay anything until you meet your Medicare deductible and coinsurance. You should also enroll in Medicare Part A if you qualify for it without paying a premium.
What Are the Advantages and Disadvantages of Having Medicare and Employer Insurance?
Having both Medicare and employ insurance coverage can offer some benefits, such as:
- Having more choices of doctors and hospitals
- Having lower out-of-pocket costs
- Having extra benefits that one plan does not offer
- Having backup coverage in case one plan denies a claim
However, having both Medicare and employer coverage can also have some drawbacks, such as:
- Having to pay premiums for both plans
- Having to follow the rules and coordination of both plans
- Having to deal with possible delays or disputes between the plans
- Having to file claims with both plans
What Are Some Alternatives to Having Medicare and Employer Coverage?
If you are not satisfied with having both Medicare Plan and employer coverage, or if you want to save money on premiums or simplify your health insurance situation, you may consider some alternatives, such as:
- Dropping your employer coverage and enrolling in Original Medicare (Part A and Part B) plus a Medigap policy and a Part D Plan. A Medigap policy is a private insurance that helps pay some of the costs that Original Medicare does not cover, such as deductibles, coinsurance, and copayments. A Part D Plan is a private insurance that helps pay for prescription drugs. This option may give you more flexibility and coverage, but it may also be more expensive and complicated than having employer coverage.
- Dropping your employer coverage and enrolling in a Medicare Advantage Plan. A Medicare Advantage Plan is a private insurance that provides all the benefits of Original Medicare plus additional benefits, such as vision, dental, hearing, and wellness services. Some Medicare Advantage Plans also include prescription drug coverage. This option may give you more convenience and value, but it may also limit your choice of providers and require you to follow certain rules and restrictions.
- Keeping your employer coverage and opting out of Medicare Part B and/or Part D. If you have employer coverage that meets certain standards, you may be able to opt out of Medicare Part B and/or Part D without paying a penalty. This option may save you money on premiums, but it may also expose you to higher costs if you lose your employer coverage or decide to enroll in Medicare later.
How Can I Make the Best Decision for My Situation?
There is no one-size-fits-all answer to whether you should have Medicare and employer coverage at the same time or choose one over the other. The best decision for you depends on your personal circumstances, preferences, and goals. To make an informed decision, you should:
- Compare the costs and benefits of each option
- Consider your current and future health care needs
- Consult with your employer’s human resources department, your health plan’s customer service, and a licensed insurance agent or broker
- Visit the official Medicare website () or call 1-800-Medicare (1-800-633-4227) for more information and assistance
We’re Here to Help
You do not have to spend hours reading articles on the internet to get answers to your Medicare Questions. Give Green Insurance Agency a Call at 904-717-1176. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.
FAQS
I want to keep my employer insurance plan. How does employer health insurance work with Medicare?
If you have group health coverage through a current employer, Medicare is usually secondary as long as your employer has 20 or more employees. Medicare becomes the primary payer once your employer coverage ends.
I am turning 65 and want to apply for Medicare. How do I enroll in Medicare if I have group health coverage through my employer?
You can still apply for and enroll in Medicare Parts A and B when you turn 65, even if you have health insurance coverage through your employer. Medicare will be secondary as long as your employer has 20+ employees.
What happens when employer coverage ends? Does Medicare become my primary insurance at 65?
Yes, when coverage through your employer ends, Medicare becomes your primary health insurance at age 65. You no longer have to worry about coordinating coverage between employers.
I have coverage through my employer. Do I have to drop my employer health insurance when I become eligible for Medicare coverage?
No, you can keep your employer coverage and have Medicare as secondary insurance. You only have to drop employer coverage if the employer has fewer than 20 employees.
If my employer has less than 20 employees, will Medicare be the primary payer over my employer health benefits?
Yes, if your employer has less than 20 employees, Medicare will be the primary payer over any employer health benefits once you become eligible for Medicare coverage.
I’m under 65 and qualify for Medicare because of a disability. Will Medicare be primary or secondary to my employer’s health plan?
If you qualify for Medicare before age 65 due to disability, Medicare is the primary payer over any coverage through your employer’s health plan.
I want to speak with a licensed insurance agent about whether Medicare will be the primary payer over my employer’s coverage. How do I find someone to help?
Contact your local State Health Insurance Assistance Program (SHIP) to speak with a licensed insurance counselor for free about coordinating Medicare with employer health benefits.
If I enroll in a Medicare Advantage Plan, can I also contribute to a health savings account if my employer offers one?
No, you cannot contribute to an HSA if you are enrolled in a Medicare Advantage Plan, since you are receiving Medicare benefits.
I want to learn about how Medicare work parts A and B. Where can I find centers for Medicare services that offer free counseling on Medicare benefits?
You can visit or call your local State Health Insurance Assistance Program (SHIP) office to speak with a Medicare counselor about Parts A and B benefits, coverage, eligibility, and more at no cost.
I take prescription drugs. How does Medicare Part D prescription drug coverage interact with private insurance companies?
Private insurance is usually secondary to Medicare Part D. Make sure to coordinate benefits with any private insurance to minimize out-of-pocket drug costs.
