You have a number of important decisions to make when you turn 65, like whether you should enroll in Medicare Part B (Medical Insurance), join a Medicare Prescription Drug Plan, buy a Medigap policy, and/or keep employer or retiree coverage. By understanding your choices, you can avoid paying more than you need to, and get coverage that meets your needs.

 

Should I get group health plan coverage? Many employers and unions offer group health plan coverage to current employees or retirees. You may also get group health plan coverage through the employer of a spouse or family member.

If you have Medicare and you’re offered coverage under a group health plan, you can choose to accept or reject the plan. The group health plan may be a fee-for-service plan or a managed care plan, like an HMO or PPO.

 

I have Medicare and group health plan coverage.Who pays first? Generally, your group health plan pays first if both of these are true:

• You’re 65 or older and covered by a group health plan through your current employer or the current employer of a spouse of any age.

• The employer has 20 or more employees and covers any of the same services as Medicare (this means the group health plan pays first on your hospital and medical bills.)

 

If the group health plan didn’t pay all of your bill, the doctor or health care provider should bill Medicare for secondary payment. Medicare will look at what your group health plan paid, and pay any additional costs up to the Medicare-approved amounts as appropriate. You’ll have to pay whatever costs Medicare or the group health plan doesn’t cover.

 

If your employer has less than 20 employees, Medicare generally pays first. But if your employer joins with other employers or employee organizations (like unions) to sponsor a group health plan (called a multi-employer plan), and any of the other employers has 20 or more employees, Medicare would generally pay second. However, your plan might ask for an exception, so even if your employer has less than 20 employees, you’ll need to find out from your employer whether Medicare pays first or second.

 

I’m in a Health Maintenance Organization (HMO) Plan or an employer Preferred Provider Organization (PPO) Plan that pays first.Who pays if I go outside the employer plan’s network? If you go for care outside your employer plan’s network, you might not get any payment from your plan or Medicare. Call your plan before you go outside the network to find out if the service will be covered.

 

I decided not to take group health plan coverage from my employer.Will this affect what Medicare will pay? Medicare pays its share for any Medicare-covered health care service you get if you don’t take group health plan coverage from your employer, and you don’t have coverage through an employed spouse.

 

What happens if I drop coverage from my employer? Medicare pays first unless you have coverage through an employed spouse, and your spouse’s employer has at least 20 employees.

 

Note: If you don’t take employer coverage when it’s first offered to you, you might not get another chance to sign up. If you take the coverage but drop it later, you may not be able to get it back. Also, you might be denied coverage if your employer or your spouse’s employer generally offers retiree coverage but you weren’t in the plan while you or your spouse was still working. Call your employer’s benefits administrator for more information before you make a decision.

 

If I’m 65 or older and still working, what health benefits does my employer have to offer me? Generally, employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer younger employees. If the employer offers coverage to spouses, it must offer the same coverage to spouses 65 and older that it offers to spouses under 65.

 

 

Source of information: www.Medicare.gov

 

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