Who Pays If You Are Medicare Eligible but Still Work
Many of us are faced with the situation wherein we continue to work past the age of 65 and so we are covered for health benefits under our employer's health plan. Who pays in that situation when we incur medical expenses, Medicare or your employer?
Under Federal law employer health plans can not discriminate against aged workers 65 and older and their spouses. These anti-discrimination laws apply if the employer has at least 20 employees. The health plan offered by your employer must contain the same health benefits for everyone in their employ, and you must be given the opportunity to accept of reject the health plan.
Also under Federal law employer plans must offer you the same health benefits under the same conditions offered to other employees if:
If you accept the employer's plan it becomes your primary plan as long as you or your spouse continue to work. If you reject the company's plan Medicare will become the primary plan. By definition the primary plan is the health plan that pays first on your health insurance claims. The secondary plan is the health plan that pays your health claims second.
If your employer's plan does not pay all of the charges, Medicare may pay secondary benefits only for Medicare covered services. Thus it may be worth your while to see if you can be reimbursed for some medical expenses that are not covered by your employer's health plan.
When you initially enroll in Medicare the questionnaire will ask you about any coverage that you may have through your employer. Medicare needs to find out if your employer or Medicare will be your primary payer.
Once you cease to be covered under your employer's health plan you have a period of 3 months within which you can enroll in Medicare medical insurance (Part B). You should also notify the insurance carrier that handles your Medicare claims. Be prepared to tell them the name and address of the employer's plan, the prior policy number, the date coverage stopped, and why. The amount of your premium for enrolling in Part B will not be increased if you enroll within the prescribed period of time.
Much of the information for this article was obtained from U.S. GPO: 1995-397-432.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin
August 21, 1999
http://www.therubins.com
To e-mail: rehabstrat1@aol.com or rubin@brainlink.com