How Do Medicare and Employer Health Insurance Work Together?
Key Takeaways
- If you delay Part B enrollment for employer health insurance, you generally can switch to or add Part B without penalty.
- While Part A of Original Medicare is usually a no-cost monthly premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. option that complements employer insurance; Part B charges a monthly premium that sometimes overlaps employer coverage.
- You should decide whether Part B or employer coverage is the right fit for you. If you determine that having both is beneficial, it’s important to understand which plan pays first.
It’s good to have choices in life.
It’s even better when you make the right choice.
If you opted against enrolling in Medicare Part B when you turned 65 because you had medical insurance through your job or your spouse’s job, then you already tackled a crucial decision related to Medicare.
But just because it was the right choice for you yesterday doesn’t mean it’s the right choice today.
Still have questions? GoHealth has the answers you need.
Call Today
Should I Sign Up for Medicare if I have Insurance at Work?
Since costs associated with employer-sponsored health plans change all the time, it might make sense for you to switch to Medicare or perhaps even add Medicare to supplement your existing plan.
How do you determine if it’s time for a change? And if it is time, how do you make that change?
Let’s dive in.
Can I Enroll in Medicare if I’m Over 65 and Retire?
This one usually is pretty straightforward but is worth mentioning: If you’re 65 or older and your employer health coverage ends, Medicare is waiting for you.
Just don’t wait too long.
When you leave a job that provides health insurance, that launches an eight-month Special Enrollment Period that allows you to sign up for Medicare without the lifetime late penalty that you otherwise would incur for enrolling after age 65. You probably knew that when you opted not to enroll in Medicare Part B during your Initial Enrollment Period surrounding your 65th birthday, but it bears repeating.
You probably won’t be waiting eight months though, since Medicare is a group health insurance plan on a grand scale that helps pay for medical expenses as you get older.
Start your Medicare PlanFit CheckUp today.
Call Today
Can I Have Medicare and Employer Health Insurance at the Same Time?
“Should I enroll in Medicare if I have employer insurance?”
While the decision to enroll in Part B after you no longer have employer insurance can be a pretty obvious one, it might also be obvious that you should pass on Part B if you have an employer plan.
But you still need to keep a couple of things in mind because there are exceptions.
If you carry both an employer plan and Part B, Medicare defines a “primary payer” and a “secondary payer,” referring to which insurance pays toward your medical expenses first.
- If you’re on an employer plan for a company that has 20 or more employees, then that plan is the primary payer. Often, Part B as the secondary payer will be left to pay little or nothing, so adding Part B coverage often isn’t cost-effective.
- If, however, your company has fewer than 20 employees, then Medicare is the primary payer. That means there are scenarios where carrying both could make sense. Your employer’s benefits department should be able to help sort out your options.
Should I Drop Employer Insurance for Medicare Once I Am Eligible?
You may be asking yourself by now, “Can I drop my employer health insurance and go on Medicare?”
Depending on the details of your employer insurance — including increased costs year over year — Medicare may be the right fit for you.
Monthly premiums for Medicare Part B historically increase each year, but so do employer premiums. If your employer plan experienced a more dramatic increase, or if you haven’t closely compared the benefits offered by your employer plan and Part B, a change could benefit you.
A GoHealth licensed insurance agent can help you determine which is right for you and also can introduce you to Medicare Advantage. Also known as Part C, Medicare Advantage plans don’t always have monthly premiums like Part B does but provide similar coverage. Our agents can review your situation, without cost or obligation.
When can I add Medicare to complement my employer plan?
When can I add or switch to Medicare if I have private insurance?
If you passed on Medicare Part B during your Initial Enrollment Period because you had insurance through the healthcare marketplace, then making a change likely will subject you to the lifetime late penalty associated with Part B. You also won’t get a Special Enrollment Period when the marketplace coverage ends, so you’ll have to sign up for Medicare during the General Enrollment Period (January 1-March 31). Coverage will take effect on July 1.
If this describes your situation, a GoHealth licensed insurance agent can help determine if you have other options.
If I’m 65 or older, can I just add a Part D prescription plan to complement my employer health insurance?
Looking for a plan with prescription drug coverage?
Find My Ideal MA Plan
Sources
- How Medicare works with other insurance. Medicare.gov.
- How to Apply for Medicare Part B During Your Special Enrollment Period. SSA.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.