Medicare and Small Employers (Less than 20 employees)
Medicare is a federal health insurance program that provides coverage for individuals who are 65 years old or older, as well as certain individuals with disabilities. However, many individuals who are eligible for Medicare also have employer health coverage. In this comprehensive guide, we will explore how Medicare works with employer insurance, the options available to individuals with both types of coverage, and important considerations for making informed decisions about healthcare.
Understanding Medicare and Employer Insurance
Medicare is comprised of two main parts: Part A and Part B. Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health services. Part B covers medical services such as doctor visits, outpatient care, preventive services, and durable medical equipment.
Employer insurance, on the other hand, is provided through an individual's employer and may vary in terms of coverage and benefits. It typically includes a combination of medical, hospitalization, and prescription drug coverage.
Both Medicare and employer insurance are designed to work together to cover an individual's healthcare needs and expenses. Medicare acts as either the primary or secondary payer depending on the size of the employer.
Medicare and Small Employers (Less than 20 employees)
If you work for a small employer with less than 20 employees, Medicare becomes the primary payer, and your employer insurance becomes the secondary payer. In this case, it is essential to enroll in both Medicare Part A and Part B to ensure coverage for your medical expenses.
While most individuals with small employer coverage enroll in Parts A and B, and stay on employer coverage as secondary insurance, some may choose to move entirely to Medicare coverage with additional supplemental plans/prescription plans or advantage plans, and disenroll from employer coverage.
Consideration for Spouse and Dependents
Medicare is individual health insurance coverage and does not extend to spouses or dependents. While most group health plans provide coverage options for dependents and spouses, Medicare benefits only apply to the eligible individual.
If you have both Medicare and employer coverage, Medicare benefits will only cover services for the primary beneficiary. Spouses and dependents will need separate coverage through the employer plan(for example, COBRA coverage or coverage through spouse’s employer) or other insurance options such as ObamaCare.