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Vol. 15, Issue 9 – May 2, 2016
How does Medicare work with my employer insurance? Dear Marci,I will turn 65 soon and be eligible for Medicare. I am still working and receive health insurance from my employer. If I sign up for Medicare, how will it work with my current employer-based insurance?

 

– Marco (Montclair, NJ)

 

Dear Marco,

 

This is a common question. As more people continue to work past age 65 and receive employer health benefits, they have questions about Medicare coverage. Learning about how Medicare works with your current employer insurance can help you decide if you want to sign up for Medicare when you become eligible. Note that when we say “current employer insurance,” we mean insurance from either your or your spouse’s job.

 

The first thing to think about is whether Medicare will pay primary or secondary to your current employer insurance. Medicare paying primary means that Medicare pays first on health care claims, and your employer insurance pays second on some or all of the remaining costs. Medicare paying secondary means that your employer insurance pays first, and Medicare pays on some or all of the remaining costs.

 

Medicare works with current employer coverage in different ways depending on the size of the employer. For people who are eligible for Medicare because they are 65 or older, Medicare pays primary if the insurance is from current work at a company with fewer than 20 employees. This is called a small group health plan. Medicare pays secondary if the insurance is from current work at a company with more than 20 employees. This is called a Group Health Plan (GHP).

 

If you have insurance from your or your spouse’s current employer when you become eligible for Medicare, you may think about delaying Medicare enrollment. If you are covered by current employer insurance—regardless of the size of the employer—you can delay Medicare enrollment without penalty. (Those who work at companies with fewer than 20 employees may want to sign up for Medicare since it pays primary. I explain further in the next paragraph.) You will have a Special Enrollment Period (SEP) to enroll in Medicare at any point while covered by the employer plan or up to eight months after the first month you are without that employer coverage. To avoid gaps in coverage, it is often wise to sign up in the month before employer coverage ends.

 

Before you delay Medicare enrollment, note that you may encounter some problems if Medicare is supposed to pay primary.

  1. Your employer plan may refuse to make payments until Medicare pays.
  2. If your employer plan pays primary but was supposed to pay secondary, it may recoup payments, leaving you responsible for the out-of-pocket costs.

 

– Marci

Health Tip
An individual’s sense of smell can decrease as they get older, but these changes are not noticeable right away. It is important for people to protect their sense of smell because it plays an important role in alerting them to danger such as spoiled food, gas leaks, and smoke from a fire. Smell disorders can also be indicative of other health conditions. To protect the sense of smell, the National Institute of Health (NIH) Senior Health recommends the following:

  1. Treat sinus and nasal conditions. Swollen sinuses and nasal passages may contribute to a decreased sense of smell.
  2. Avoid head injuries, and seek treatment if you suffer such an injury. Head injuries can lessen an individual’s sense of smell.
  3. Avoid exposure to toxic chemicals. Wear a respirator when using paints and insecticides.
  4. Treat other conditions. Individuals with diabetes, thyroid abnormalities, or certain vitamin deficiencies may experience a loss of smell or taste.

 

To read more suggestions from NIHSenior Health, click here.

 

Need to Know
Introducing a brand-new Medicare InteractiveThe Medicare Rights Center is excited to share with you our brand-new Medicare Interactive (MI) website. We encourage you to create a free MI profile today!Some features include:

  • New and improved resources. MI’s new design and features ensure you’ll find the answers you need quickly– through smart links to relevant MI pages and case examples, a roll-over glossary, and other helpful resources.
  • MI Pro: A web-based curriculum. For those looking to dig deeper into Medicare, please check out the Medicare Interactive Pro (MI Pro) learning curriculum, which will evolve further in the coming months. As an MI Pro subscriber you’ll access exclusive in-depth Medicare content, quizzes, and printable learning tools.
  • Free Medicare Interactive profiles. By creating your free MI profile, you can bookmark your favorite pages, manage newsletter subscriptions, access free exclusive links/downloads, and receive notices about key Medicare dates. As an initial thanks for registering you’ll receive a welcome e-packet from Medicare Rights, complete with our New to Medicare Guide. 

Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.

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