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Medicare

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

Actively working for an employer under 20 employees
  • Medicare is the primary payer
  • Active employees age 65 and older MUST enroll in Medicare Part A and B
  • Employee may be better off enrolling in a Medicare Advantage plan (Part C with Part D; First requires Parts A and B)
Actively working for an employer over 20 employees
  • 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)
Actively working for an employer with controlled ownership of multiple companies
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: If you are on Medicare-Disability (under age 65), Medicare is the primary payer for employers less than 100 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

Medicare Part D

Prescription Drug Plan

 

Medicare Part B

Outpatient Care: Doctor visits, lab tests, diagnostic screenings, etc.


Optional Add-on

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.