medicare and work insurance

[mathjak107]

a friend is asking me if their work insurance is primary and has medicare as a secondary (part A )

if work insurance has a 4500 dollar out of pocket ,does medicare pick that up as a secondary?

does medicare as a secondary pick up specialist copays in this situation? or an emergency room visit which under their work plan has a 400 dollar deductible.

so i am not sure exactly what medicare as a secondary will pay


i can’t seem to find anything on this

[Hemlock140]

I have been on Medicare for 6 years now while working and having a plan through my employer. Yes, Medicare is secondary and pretty much useless. During that time I had several major problems including cancer with 7 surgeries and 7 months of chemo. In all that time, to this day, Medicare has only paid $30 toward one hospital visit. Everything else has been paid my my employer plan and myself, up to my $2,000 annual maximum out-of-pocket. I hit that in 2019, 20, 21 and 22.

[ged_782]

Originally Posted by mathjak107

a friend is asking me if their work insurance is primary and has medicare as a secondary (part A )

if work insurance has a 4500 dollar out of pocket ,does medicare pick that up as a secondary?

does medicare as a secondary pick up specialist copays in this situation? or an emergency room visit which under their work plan has a 400 dollar deductible.

so i am not sure exactly what medicare as a secondary will pay


i can’t seem to find anything on this

Assuming this person has Part A only, along with their employer insurance, then Medicare is normally secondary in that situation, as Hemlock states. But Part A is Hospital coverage only, and will not cover Specialist visits, ER, Urgent Care, Outpatient, etc.

A lot of people still on employer group insurance will take Medicare Part A when eligible, because they have already paid for it through withholding. Only downside is they can no longer contribute to an HSA if they do that.

Just my experience with employer group insurance, is that a $4500 annual MOOP is pretty low, and a $400 deductible is really low, at least it is these days.

[GWoodle]

Originally Posted by mathjak107

a friend is asking me if their work insurance is primary and has medicare as a secondary (part A )

if work insurance has a 4500 dollar out of pocket ,does medicare pick that up as a secondary?

does medicare as a secondary pick up specialist copays in this situation? or an emergency room visit which under their work plan has a 400 dollar deductible.

so i am not sure exactly what medicare as a secondary will pay


i can’t seem to find anything on this

Remember that Part A only applies if one is admitted to the hospital, Mostly covers a number of days in the hospital & rehab days after that.

So if most of the services are considered outpatient that would be covered under Part B. Since that is not part of the plan here the cost goes to the work insurance,

[Lillie767]

As a general rule, Medicare will determine how much it would pay under its own rules.

If this has already been paid by the primary insurance, Medicare does not pay anything. Usual scenario.

If Medicare determines it would have paid more than the primary insurance, it will pay the difference between what has been paid and what it would pay. Rarely happens.

[mathjak107]

So basically except for hospital you are subject to the terms of your work insurance

[Lillie767]

Originally Posted by mathjak107

So basically except for hospital you are subject to the terms of your work insurance

The assumption has been that the employee has only signed up for Medicare Part A (because it has no additional premium), but not Part B because they have coverage under their employer's plan and would have to pay the Medicare Part B premium for little or no additional benefits.


This sheet from CMS actually does a pretty good job of explaining what coverage to take and what coverage to postpone if you attain age 65 and are covered under your employer's (or spouse's employer's) plan.

https://www.cms.gov/Outreach-and-Edu...rt-A-and-B.pdf

From the CMS Fact Sheet:

I have health insurance based on my (or my spouse’s) current employment, from an employer with 20 or more employees.


Your decision to enroll in Part A and Part B depends on whether you have a high-deductible health plan with a health savings account (HSA):

I do NOT have a Health Savings Account (HSA)
Part A: If you qualify for premium-free Part A, you should enroll in Part A when you turn 65. However, if you have to pay a premium for Part A, you can delay Part A until you (or your spouse) stop working or lose that employer coverage. You will NOT pay a penalty for delaying Part A, as long as you enroll within 8 months of losing your coverage or stopping work (whichever happens first).

Part B: You can delay Part B until you (or your spouse) stop working or lose that employer coverage. This allows you to save the cost of your Part B premium. It also allows you to postpone your one-time “Medigap open enrollment period” until a later time, when you may want to purchase this type of coverage. You will NOT pay a penalty for delaying Medicare, as long as you enroll within 8 months of losing your coverage or stopping work (whichever happens first). You’ll want to plan ahead and enroll in Part B at least a month before you stop working or your employer coverage ends, so you don’t have a gap in coverage.



I have a High-Deductible Health Plan AND a Health Savings Account (HSA)
Once you enroll in any part of Medicare, you won’t be able to contribute to your HSA. If you would like to continue making contributions to your HSA, you can delay both Part A and Part B until you (or your spouse) stop working or lose that employer coverage. You will NOT pay a penalty for delaying Medicare, as long as you enroll within 8 months of losing your coverage or stopping work (whichever happens first). You should talk with your employer benefits manager about whether it makes sense to delay Part A and Part B

[old fed]

Originally Posted by mathjak107

So basically except for hospital you are subject to the terms of your work insurance

I'm guessing it works the same as mine which is employer provided insurance (but am retired) and I only carry part a.

part a is primary for hospital stuff, anything else is picked up by employer provided plan with applicable OOPs and copays/co-insurance/deductible