[x_blockquote cite=”Zayden (Buffalo, NY)” type=”left”]Dear Marci,
How does Medicare coordinate with insurance from an employer?
Medicare and current employee insurance will work together in different ways under different circumstances. Without knowing your specific situation, a simple answer is not possible. Instead, let’s go over some of the most common instances where the two forms of health insurance coverage coordinate:
4. You are self-employed. If you are self-employed and provide coverage for yourself and at least one other person, Medicare considers you to have current employee insurance. (Medicare calls this a group health plan through current employment status, since you are offering coverage to at least one other employee.) A group health plan for a self-employed individual often pays secondary to Medicare, so you usually need to enroll in Medicare Parts A and B, which will pay primary. If you have coverage through an association, such as the local Bar Association, you are also considered to have current employee insurance.
Zayden, if your current employee insurance is supposed to pay primary, there are certain things that the employer and the plan cannot do. Once you are eligible for Medicare, the employer cannot (a) offer different coverage than the coverage offered to employees who are not eligible for Medicare, (b) refuse to cover you, or (c) restrict your coverage.
The employer-based plan cannot (a) charge you more for your premium, deductible, coinsurance charges, and/or copays, (b) limit the benefits you receive, (c) give you misleading information to get you to disenroll, (d) pay providers less for services, (e) require you to wait longer for your coverage to begin, and (f) end your coverage because you become eligible for Medicare.
You should call the Social Security Administration (SSA) at 800-772-1213 to answer any questions you might have about whether or not you are considered currently employed or covered by current employee coverage. Write down the date and time of the call, the name of the representative you spoke to, and the outcome of the call. You should also speak with the human resources department of the employer that provides your coverage if you have questions about how your employee coverage works with Medicare.