Perspective               

Coordinating Benefits for People with Disabilities

If you are on Medicare because of a disability and you also have other health insurance from an employer, like many people, you may be confused about which insurance pays first. The answer depends on whether you or your spouse is currently working and, if so, the number of employees in your company.

If you and your spouse are not actively employed, Medicare is almost always primary (which means it pays first), and your retiree coverage through a former employer is secondary (which means it pays second).

If you or your spouse has health insurance through your or your spouse’s current employer, and the employer has at least 100 employees, then your employer health coverage is primary and Medicare is secondary. In this case, you do not need Medicare. But, if you want to pay the $43.80 Medicare B monthly premium, Medicare may help pay for services your employee insurance does not pay for such as mental health care.

If you have health insurance through your or your spouse’s current employer, but the employer has less than 100 employees, then you generally must enroll in Medicare Parts A and B to continue getting health insurance coverage. In this case, Medicare becomes your primary insurer. You can sometimes postpone enrolling in Medicare and continue using your employer group health plan as your primary coverage, but only if your employer plan does not require Medicare eligible employees to enroll in Medicare. Check your employer health plan policy for details.

Don’t worry about not joining Medicare if you stay with your employer health plan while you are still working. Once you or your spouse retires or drops your employer insurance, you will be eligible for an 8-month Medicare Special Enrollment Period, when you will be able to enroll in Medicare without any penalty.

For More Information, Contact: Beth Demel, (212) 869-3850, ext. 18.

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