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Understanding Medicare
Medicare is a government health insurance program administered by the Centers for Medicare & Medicaid Services for those who are 65 or older, under 65 with certain disabilities, or for those who have End-Stage Renal Disease at any age. With around 40 million Americans participating, Medicare is the largest health insurance service in the country.
It is important to recognize when or if you need to elect Medicare if you are 65 or older and actively employed, or if you are a spouse (65 or older) of an actively employed individual. If you do not enroll correctly, you may be subject to penalties by Medicare and claims could be denied or partially paid.
Medicare Enrollment
If you are collecting Social Security benefits, you should be automatically enrolled in Medicare Part A when you turn 65. If you are not collecting Social Security benefits, you will need to contact the Social Security office to enroll in Medicare or you can enroll via the web at socialsecurity.gov/medicare.
Medicare When You Are Actively Employed
- Medicare is the secondary payer if you have employer coverage
- Active employees 65 and older can enroll in Part A (no cost) but do NOT need to enroll in Part A or Part B
- Employee may be better off enrolling in a Medicare Advantage plan (Part C and Part D) as the premiums may be significantly reduced (First require Parts A and B)
- Medicare is the secondary payer if you have employer coverage
- Active employees 65 and older can enroll in Part A (no cost) but do NOT need to enroll in Part A or Part B
- Employee may be better off enrolling in a Medicare Advantage plan (Part C and Part D) as the premiums may be significantly reduced (First require Parts A and B)
| Number of Employees | Who Owns the Policy | Primary Payer |
|---|---|---|
| All entities employ less that 20 employees | At least one employer has more than 20 employees | At least one employer has more than 20 employees |
| One policy for all entities | One policy for all entities | Each entity has its own policy |
| Medicare is primary for all entities. Employees should enroll in Medicare. | Employer is primary. Employees not required to enroll. | Employers is primary ONLY for the entities that have +20 employees |
Important information for individuals enrolled in or eligible for Medicare
- You are no longer able to contribute towards a Health Savings Account (HSA) if you are enrolled in any parts of Medicare
- You must maintain a plan with Creditable Prescription coverage (see Bond “Compliance Packet” to determine if the plan you are enrolled in has Creditable Prescription coverage). If you do not have creditable drug coverage, your future Medicare Part D premiums will be penalized by paying a higher premium
- You have the option of purchasing a Medicare Advantage (MA or Part C) plan with or without prescription drug coverage (Part D) directly from various insurance companies (Excellus, MVP, etc.)
- Please see www.medicare.gov for more information on Medicare
Medicare Part A
Inpatient Care: Hospital stays, skilled nursing services, hospice care, etc.
Optional Add-on
Inpatient Care: Doctor visits, lab tests, diagnostic screenings, etc.
Prescription Drug Plan
Inpatient Care: Hospital stays, skilled nursing services, hospice care, etc.
Inpatient Care: Doctor visits, lab tests, diagnostic screenings, etc.
Medigap
Medicare Supplemental
Insurance Pays for services NOT covered by Part A or Part B.
Medicare Advantage
Includes same coverage as Original Medicare (Part A & B) and may include extras such as prescription drug coverage (Part D), vision, hearing, dental care and more. Purchased from Medicare approved, private provider.
Optional Add-on
Medicare Part D
Includes same coverage as Original Medicare (Part A & B) and may include extras such as prescription drug coverage (Part D), vision, hearing, dental care and more. Purchased from Medicare approved, private provider.