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How Does Medicare Work with Employee Benefits?

This is one of the most commonly asked questions we receive daily. Many people are making the choice to continue working past age 65, and they are covered under their, or a spouse’s, employee health benefits. Without a doubt that can lead to questions and confusion on how to precede once a person becomes eligible for Medicare.
Learning how Medicare works with your current insurance can help you to determine if you should sign up for Medicare when you are first eligible.
 
Your Employer and Medicare Part A
Most workers choose to enroll in Part A Medicare because you usually do not pay a monthly premium for it if you or your spouse paid Medicare taxes while working for at least 40 quarters, which is 10 years. Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided by Hospice. Having Part A alongside a group plan can significantly reduce an inpatient deductible.
 
Your Employer and Medicare Part B
Medicare Part B, which covers outpatient and preventative care such as doctor’s visits and tests, has a monthly premium amount that changes yearly. The standard Part B premium amount for 2021 is $148.50 a month (or higher depending on your income).
 
Whether you should enroll in Part B while you are still working depends on how many people work for your employer.
 
If Your Company Has More Than 20 Employees
If the company has 20 or more employees, you most likely would not have to sign up for Part B right away as your employee health plan would be the primary insurer. Primary Insurers pay first. In most cases you do not need Part B Medicare if you have employer coverage that pays primary unless you are unhappy with that coverage, or have a very large deductible. You will want to consider if paying for both types of coverage would offset your health care costs, or whether it would be cheaper to have one or the other.
 
If Your Company Has Less than 20 Employees
If there are less than 20 employees you should enroll in Part B when you are first eligible. Medicare would be the primary insurer, meaning that they would pay before your employee insurance pays. In this case, if you do not enroll, your employer’s plan can refuse to cover you for services that Medicare would have covered. That means you would be responsible to pay for those services out of pocket.  
 

Do you have questions about Medicare? Speaking with our licensed Medicare professionals really is the secret to mastering great healthcare and getting your Medicare right the first time.
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