This is a very common question and the answer will depend on several factors. While the topic can be overwhelming there is no need to over stress.
Factors that can affect the answer include:
- Employer Size
- Veteran Benefits
- End Stage Renal Disease (ESRD)
First you’ll want to understand how your employer group coverage will be affected once you are eligible for Medicare. Your group coverage through your employer could be affected even if you don’t sign up for Medicare when you turn 65, so pay close attention.
Coordination of Benefits
The first big thing about Medicare we need to cover, in relation to our topic, is coordination of benefits. According to Medicare.gov coordination of benefits ‘is a way to figure out who pays first when two or more health insurance plans are responsible for paying the same medical bill’. While it’s logical to think that this only applies when you have two insurances, the truth is that its not. Some group insurances could deny paying a bill just because they know you are eligible for Medicare.
The reason for this is because Medicare has set rules on who pays a bill first. An ample list of scenarios can be found on a document called “Who pays First” created by the Center for Medicare and Medicaid Services (CMS). It’s available on Medicare.gov.
Employer Group Size
What you need to know is if your employer insurance plan is suppose to pay first or not. For most is as easy as knowing if your employer group has less than 20 employees or not. If your employer has less than 20 employees then Medicare becomes the “primary payor”, which basically means that they are suppose to pay the bill first. Now here is the tricky part, this applies even if you haven’t signed up for Medicare yet. Wait, what?
Yes, if you are 65 and are eligible to enroll into Medicare your less-than-20-employee-small-group-employer policy will likely reject any bills that are sent to them. They’ll want those bills to be sent to Medicare first because “Who wants to pay a bill they don’t have to?”. So in this case if someone is turning 65, still working and their employer has less than 20 employees, they should sign up for Medicare A & B because Medicare is the primary payor. Now, can they still keep their small group insurance plan? Technically yes but one would be wise and factor in the costs of keeping both coverages, in some cases it might be a good idea but it all depends.
So what if my employer has more than 20 employees, should I sign up for Medicare if I’m still going to be covered by my employer health plan? The answer is probably not because you’ll be paying for two insurances that likely won’t save you money on your healthcare bills. If this applies to you, factor how much you’ll be paying for your employer coverage and what sort of cost-share it has (deductible, co-pays, coinsurance etc) when you get treatment. It’s also important to understand what Medicare covers and what it doesn’t. Does it include prescription drugs or do you have to buy it separately?
I did mention that there are other factors to consider, the article “Who Pays Firsts” gives more information but you are welcome to post your questions in the comments, I’ll be happy to answer them. Or if you prefer to contact us directly navigate to our contact section on top.
Here is a link of the article Who Pays First.