You Need Part B If Medicare Is Primary

What is Medicare Part B? It is your outpatient coverage.

Once you retire and have no access to other health coverage, Medicare becomes your primary insurance. Part A pays for your room and board in the hospital. Part B covers most of the rest.

The Medicare definition for Part B is outpatient coverage. However, Part B covers many things that happen both in and out of the hospital. Part B provides 80% coverage for doctor visits, labwork, physical therapy, medical equipment, diabetes supplies, surgeries, chemotherapy, radiation, dialysis and much more.

Is Medicare Part B optional? Yes, because some people who are still working may wish to delay it until they retire.

However, it is a critical component of your overall health package when Medicare is primary.

Some common scenarios where Medicare is primary are:

• When you are 65 or older and have employer coverage at a company with less than 20 employees
• When you are under 65 on Medicare due disability and work for an employer with less than 100 employees
• If you have retiree coverage from a former employer
• With COBRA insurance, you must enroll in Part B by the 8th month of COBRA
• When you are turning 65 with Tricare for Life or CHAMPVA
• When you are 65 or older and enrolled in Medicaid

Employer coverage, retiree coverage, COBRA, TFL and Medicaid all function as your secondary insurance only if do your part and first enroll in Part B. Failure to enroll in Part B means you will also owe a penalty if you decide to enroll later on.

Medicare Requirements Impacting Your Calpers Health Coverage

If you’re Medicare eligible and you lose your Part A and/or Part B, you’ll be disenrolled from the CalPERS Medicare health plan. Your disenrollment from Part A and/or Part B may result in cancellation of your CalPERS health coverage.

CMS requires members to live in the approved plan service area and list a residential address. Post Offices Boxes are not permitted. If CalPERS is unable to verify your permanent residential address, your enrollment may be subject to cancellation, or you may be administratively enrolled in a Medicare Supplement plan to continue your CalPERS health coverage.

CMS must approve your enrollment in a Medicare Advantage plan and Medicare Part D plan. CalPERS and/or your CalPERS Medicare health plan may contact you to obtain additional information required by CMS to complete your enrollment. If you’re contacted for additional information, respond immediately to protect your health coverage.

You may be enrolled in only one Medicare Advantage plan at one time, as well as one Medicare Part D plan at one time. If you’re enrolled in a CalPERS Medicare health plan and later enroll in another Medicare health plan, you’ll be disenrolled from the previous Medicare health plan.

Do I Have To Get Medicare If Im Covered By My Spouses Employer Plan

Most people are first eligible to sign up for Medicare when they turn 65, and many choose to enroll during this time. For individuals who are covered by a spouses employer health care plan, it may not be necessary, or ideal, to enroll in Medicare immediately upon turning 65.

If you are covered by your spouses employer plan and eligible for Medicare, you may have a few options when it comes to getting Medicare. You can:

• Enroll in Medicare when you turn 65
• Enroll in only Medicare Part A when you turn 65
• Delay Medicare until you lose your coverage

Before making any decision though, you should always talk with the employers health care benefits department to understand how Medicare may or may not work with your current coverage. Now lets explore each of the options above.

Don’t Miss: Can You Get Supplemental Health Insurance Through Obamacare

About Medicare Part B And Part D

As you research more about what Medicare covers, youll likely learn that there are deadlines and late enrollment penalties associated with Medicare Part B and Medicare Part D . Generally, you can enroll in Medicare Part A and put off enrolling in Part B when you keep the health plan of the employer you still work for. As for Part D, your employers insurance plan must be considered creditable by Medicare, which means the drug coverage it provides must be at least as good as Medicares coverage.

If youre still unsure about whether you qualify to keep your employer insurance coverage when you turn 65, check with your human resources department for more information. Once you know whether you qualify, you dont have to evaluate whether you should keep your employer plan on your own. The State Health Insurance Assistance Programs provides free information and insurance counseling that anyone becoming eligible to receive Medicare can utilize.

Why Enrolling Is Important

It is advisable to enroll for Part A when you become eligible for Medicare, even if you still have an employer health plan. Part A is premium-free for most people and covers hospital costs, skilled nursing care, home health care, and other services, so it will do more good to enroll. For those who have health insurance that would not be considered creditable coverage, then delaying Medicare enrollment could cause gaps in coverage and cause late enrollment penalties to incur, which are typically permanent.

For support in comparing Medicare coverage with your employer health plan, our team is here to help. We will help you select the right coverage to provide you with peace of mind as you move towards retirement. Give us a call today at 972-331-1060.

Stay connected with us:

Read Also: Eligibility For Aarp

Recommended Reading: Can I Add A Friend To My Health Insurance

Give Employees Cash To Purchase Their Own Insurance

Employers and employees health care costs continue to skyrocket. A solution is to allow employers to give employees pre-tax cash to purchase their own health insurance. This move, enabled by a newly enacted federal rule, would put competitive pressure on insurers, driving down costs, and leave more cash in employees pockets.

In 2018, American corporations spent $962 billion on health care, a mammoth sum that should significantly influence the health care system. Despite this leverage, U.S. firms continue to struggle with spiraling costs. From 2013 to 2019, the price of health insurance premiums for corporate family plans grew by 22%, dwarfing the growth in overall inflation and workers earnings as a percentage of income.

In response to these price hikes, all too many firms have sought better prices from health insurers by increasing out-of-pocket employee payments, yet have not passed on the savings to employees. By 2019, employees share of health insurance premiums had grown from 26% to 30%, and deductibles had more than tripled. Thirty percent of covered employees were in plans with deductibles averaging a hefty $4,673 to $5,335 for various family high-deductible health plans. Underinsurance grew, with 28% of workers lacking complete financial protection.

Insight Center

Can My Medicare Part B Enrollment Start The Day My Work Coverage Ends

Yes, you should be able to enroll in your Medicare Part B a few months in advance and select a future Part B start date. That way you can time it that when your work coverage ends, your Medicare Part B all start at the same time. You should not have a gap when your work coverage has ended but your Medicare has yet to begin.

You May Like: How To Become A Health Insurance Broker In California

Determine If Medicare Or Group Insurance Is The Primary Insurer

The size of your employer often decides whether or not you can delay enrollment in Part B without paying a penalty. In companies with fewer than 20 employees, Medicare automatically becomes the primary insurer, with group insurance secondary. If you learn that your current insurance will become secondary to Medicare, then you should take Part A and Part B when you are first eligible. The reason for this is because secondary insurance only pays after the primary insurer pays, and pays very little. If you choose to delay Medicare, you will not have a primary insurer, and your out-of-pocket costs will be high.

On the other hand, if your employer has more than 20 employees and you learn that your group health insurance will remain the primary insurer with Medicare coverage second, then you may not need to enroll in Part B immediately as your current coverage will cover your needs.

What Forms Do I Need To Show Creditable Coverage From An Employer

You will need your employer to fill out the CMS-L564 form. This form is a request for employment information and will provide proof of creditable coverage to Medicare. Once the employer completes Section B of the form, send in the document with your application to enroll in Medicare. You can avoid the Medicare Part B penalty if you do this correctly.

Read Also: Why Do You Need Health Insurance

Certifying Your Medicare Status

If CalPERS is unable to obtain your Medicare information from the CMS and cannot automatically enroll you in a CalPERS Medicare health plan, you must certify your Medicare status to continue your CalPERS health coverage.

Complete and submit the Certification of Medicare Status form with supporting documentation certifying one of the following choices:

• Enrolled in Medicare Part A and Part B
• Ineligible for Medicare either in your own right and/or through the work history of a current, former, or deceased spouse
• Deferring enrollment in Medicare Part B due to your or your spouses employment

If you do not meet these requirements, you’ll receive a notice of cancellation of health coverage for yourself and all enrolled dependents the month you turn 65. Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65.

If you’re ineligible for Medicare Part A at no cost, you must complete and submit the Ineligibility of Medicare Certification form or the Certification of Medicare Status form with the reason for your ineligibility:

• Did not work in employment covered by Social Security/Medicare
• Do not have 40 quarters in Social Security/Medicare-covered employment
• Do not qualify through the work history of a current, former, or deceased spouse

• You’re still working and have active employer group health coverage.
• Your spouse is still working and you’re covered under their active employer group health coverage.

Your Employer Offers Coverage But You Think Its A Lousy Plan

Under the Affordable Care Act, employer sponsored plans must cover at least 60% of medical expenses for a standard population. In that case, the employee pays 40% of their health care expenses through deductibles, coinsurance and copayments. Your plan will state whether it meets the percentage requirement.

Similarly, your boss could offer a plan that you think is too expensive and that you cant afford it. However, you may find that prices on the individual market are high, too.

Note that if you decline your employer-based insurance, youll forfeit any financial assistance your employer offers to cover its cost. Plus, you wont be eligible for premium tax credits for a marketplace plan if your job-based insurance is deemed affordable and meets minimum value requirements under the law.

Recommended Reading: Does American Family Have Health Insurance

Medicare Premiums And Employer Contributions

According to the Centers for Medicare & Medicaid Services , it is illegal for employers to contribute to Medicare premiums for an employee with Medicare and employer coverage. However, there is an exception for employers who set up a 105 Reimbursement Plan for all employees.

The reimbursement plan deducts money from the employees salaries to buy individual insurance policies. Beneficiaries who participate can receive tax-free reimbursements for their Medicare Part B premium.

Get A Free Quote

Find the most affordable Medicare Plan in your area

A well-known Section 105 plan is a Health Reimbursement Account. An HRA reimburses eligible employees for their Medicare premiums and other medical costs.

How Costly Is My Employer Plan Outside Of Premiums

Your premiums are only one expense you’ll bear in the course of having health insurance. You’ll also need to deal with deductibles, copays, and coinsurance, and that’s where it pays to run the numbers and see whether your employer plan comes in cheaper than Medicare. In 2020, Medicare Part B comes with an annual deductible of $198. Meanwhile, your deductible per hospital stay under Part A is $1,408. Compare these numbers to what your employer plan charges to get a more comprehensive cost comparison.

You May Like: How To Make Health Insurance Affordable

If You Apply For Medicare And Keep Employer Coverage What Are The Out

If you apply for Medicare, be aware that itâs not free. Most people pay a monthly premium for Medicare Part B . However, you may be eligible to receive premium-free Medicare Part A , as explained above. You may want to apply for Medicare Part A if you want when you are first eligible, and apply for Medicare Part B later when you lose your employer coverage. That might be a cost-conscious way to increase your insurance coverage if you decide to have both Medicare and employer coverage.

Medicare Part A and Part B have deductibles, copayments and coinsurance costs. For example, youâll typically pay 20% after youâve met your annual Part B deductible for medical services and supplies covered under Part B.

What about the other âpartsâ of Medicare â Part C and Part D ? These Medicare coverage options might charge monthly premiums. And you still need to keep paying your Part B premium as well â if you have Part B. You must be enrolled in Medicare Part A and Part B to qualify for a Medicare Advantage plan under Medicare Part C.

Itâs usually simple to find out your employer coverage costs. You can probably see the deduction in your paycheck for your health plan premium. If youâre happy with the coverage, and feel the costs are affordable, you may want to keep it.

Review the deductibles and coinsurance cost-sharing amounts of your employer coverage. Increasingly, employer coverage might also include deductibles and coinsurance or copayment amounts.

What Should You Consider Before Enrolling In Medicare

Before dropping employer coverage to enroll in Medicare, consider all the options that are or will become available once Medicare is elected. Remember the limitations of Original Medicare and the options available through MA and Medicare Supplement Plans. Consider these questions:

• How much will you pay in monthly premiums for each plan?
• How much will you pay for deductibles, copays, and coinsurance for both medical and pharmaceutical services?
• Are your current doctors, prescriptions, labs, and hospitals covered?
• Do the plans cover potential future needs such as out-of-network hospitals, cancer treatment centers, and specialists?
• What will you pay for dental, vision, and other benefits not covered by Original Medicare?
• Employer plans may have separate coverage for medical and drugs from that of dental and vision coverage. Check with the benefits department to see if you can keep one without the other.
• MA Plans may offer vision, dental, and hearing coverage.

Don’t Miss: How Much Does Health Insurance Cost If Self Employed

Do I Need To Get Medicare Drug Coverage

You can get Medicare drug coverage once you sign up for either Part A or Part B. You can join a Medicare drug plan or Medicare Advantage Plan with drug coverage anytime while you have job-based health insurance, and up to 2 months after you lose that insurance.

Even if you have a Special Enrollment Period to join a plan after you first get Medicare, you might have to pay the Part D late enrollment penalty. To avoid the Part D late enrollment penalty, dont go 63 days or more in a row without Medicare drug coverage or other .

If you have other drug coverage: Ask your drug plan if its creditable drug coverage.

Each year, your plan must tell you if your non-Medicare drug coverage is creditable coverage. Keep this information you may need it when youre ready to join a Medicare drug plan.

Rate And Comment On The Answer

This site uses Akismet to reduce spam. .

Answer Rating:

If they can afford it? My employer, less than 50 people pays half of my premium and none of my husbands. Both our full premiums come to 1300. Employer pays about 300 of my coverage so would cost me 1000 a month. I only take home after paycheck taxes around 2000. My house payment is 850 a month. Only leaves me enough to put gas in my car to get there. Will I be homeless but have coverage? So I signed up through marketplace and receive assistance through Obama Care. I pay 240 each month as even this was hard to adjust my budget. I have been told that I will have to pay back all of my assistance. I have also been told to quit my job.

Answer Rating:

I have been told same thing. Quit my job . is it better for everyone to go on public assistanceI cannot afford 700.00 monthly insurance throughMy employer but I can squeeze by on the obamacare 240.00 a month. Why cant I still get the entitled discounts

Dont quit your job. That is not a good solution. What you can do is looking into affordability exemptions from employer coverage. You can also straight up ask your employer like seriously guys, why are you offering a $700 a month plan after employer contributions?!?!

Im a full time employee whos work doesnt offer health insurance im not a free loader, and I love Obamacare Obamacare literally saved my life. F Trump.

The ACA is a disaster period, its very expensive, so far it hasnt helped me.

Read Also: What Is Gap Health Insurance And What Does It Cover