Medicare as Secondary Insurance (HSA, medical, plan, doctor)
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My sister, who is employed full-time with health care coverage, will turn 65 in a few months. Her husband is covered under her employer insurance, and he will not turn 65 until late 2018. She must maintain her employer insurance in order to maintain his coverage, with her employer insurance being the primary payer and Medicare the secondary payer for her medical expenses. This has led to a multitude of questions with answers hard to find. My Medicare situation was far simpler, and I have not been able to help her. If anyone can help with a couple questions, we would very much appreciate it.
1) Her employer insurance has a deductible, as well as a co-pay for doctor's visits, lab work, etc. In addition to signing up for Medicare Part A, will she also be required to enroll in Medicare Part B in order to have Medicare pay the portions of doctor's visits, etc that are not paid by her work insurance?
2) How much will Medicare pay as the secondary payer? Will it pay 100% of deductible and co-pays?
What else does she need to know? Thanks very much for your help.
Hmm. In my experience Medicare is the primary and the other insurance is secondary.
According to her employer's insurance company, they are primary and Medicare is secondary. That's consistent with "Medicare & You 2018" manual: "If you're 65 or older, have group health plan coverage based on your... current employment and the employer has 20 or more employees, your group health plan pays first."
Everyone, including her HR department are in agreement with that part, but no one has been able to answer the other questions.
And yes, she is still employed full time, which makes a big difference in Medicare's role.
1) Her employer insurance has a deductible, as well as a co-pay for doctor's visits, lab work, etc. In addition to signing up for Medicare Part A, will she also be required to enroll in Medicare Part B in order to have Medicare pay the portions of doctor's visits, etc that are not paid by her work insurance?
2) How much will Medicare pay as the secondary payer? Will it pay 100% of deductible and co-pays?
Unless her employer insists she do so or her employer employs fewer than 20 people, she is not required to enroll in Medicare at all until she loses her employer coverage. When she finally retires/quits, she then enrolls in Medicare Part B without penalty.
#1 - only in part. #2 - No. Medicare will only pay its 20% after satisfaction of the Part B $183 deductible - based on Medicare rates. Since Medicare is secondary while she works, her providers will NOT be charging the lower Medicare rates, so Medicare's portion, if any, will be very small.
Keep in mind, the Medicare Part B premium is $134/mo., or $1,608/yr. Unless she does a lot of doctoring, it is unlikely enrolling in Medicare now will be cost-effective.
I worked until 67-1/2. My employer insurance was primary. Employer told me I did not need Medicare. I enrolled in Parts A and Part B when I retired.
Keep in mind, if she is participating in an HSA, she cannot do this as a Medicare beneficiary. Since she isn't collecting SS and is still working, she should not automatically be enrolled in Medicare Part A when she turns 65. If she is, she needs to disenroll in order to continue in the HSA.
Last edited by Ariadne22; 10-28-2017 at 02:27 PM..
Thank you very much, that is very helpful. I'm not sure if she has considered delaying enrollment, or whether her company is requiring her to enroll, but it sounds as if delaying Medicare entirely until she retires may be her best option. She definitely needs to explore that further. Thanks again.
Thanks very much. I had not found that checklist, and it's got some good info.
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