A wife has retired but her husband is still working. They both have husband's employer sponsored health insurance (more than 20 people). Will the retired wife enrolling in premium-free Medicare Part A (based on her husband work history) impact on her current employer sponsored health insurance such as changing from primary to secondary etc or no impact at all? Thank you for your answer.
Will enrolling in Medicare Part A impact on one's employer sponsored health insurance?
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sbg_ben
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You can use this link, answer the questions and it will tell you, I did it for your situation and here is what it says. [EXTERNAL LINK] - How Medicare works with other insurance
Your answer:
The group health plan pays first, and Medicare pays second.
What if my plan has opted out?
If the group health plan didn't pay your entire bill, your provider should send the bill to Medicare for secondary payment. You may have to pay any costs Medicare or the group health plan doesn't cover.
Note: If you're in a Health Maintenance Organization (HMO) Plan or an employer Preferred Provider Organization (PPO) that pays first, and you get services outside the group health plan's network, it's possible that neither the plan nor Medicare will pay. Before you go outside the plan's network, call your plan to find out if it will cover the service.
What else do I need to know?
Call your benefits administrator before you make any changes or sign up for Medicare drug coverage.
If you have employer or union coverage and get Medicare drug coverage, you may lose your employer or union health and drug coverage (for you and your dependents). If this happens, you may not be able to get your employer or union coverage back. This is true even if you get Extra Help.
In the experience of agents how much does the coordination of benefits pay ?Let's say I have $2 k deductible and my max out of with my big group plan is $5 k . I go in hospital and bills $30 k . I have part A . Of that $5 k max out of pocket I owe roughly how much of that will Medicare Part A pay ?
COB, including Medicare, is based on how much the primary carrier pays vs how much the secondary carrier would have paid if they were primary.
Only a fool would speculate how much an insured would have to pay in a COB situation.
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I am NOT an agent. I am a Medicare Beneficiary. (Using OM, HD Medigap, and PDP.)
I am going to give you a very general "opinion" answer based on experience with Part B. (Numbers are rounded, but they will show you what I want you to see.)
To your question, probably not a lot, relatively speaking. Original Medicare allowed amounts, deductibles, and COB rules will (probably) make a dramatic reduction in liability amounts.
3 years ago (so amounts are probably not too out of date) I had a hip replacement. I had the surgeon use a local hospital's clinic facility.
Assume I had already met my Part B deductible earlier in the year.
The hospital's outpatient billing for services was $142,500. Medicare said $500 was for self administered medication and I was liable to the hospital for that charge. There was $4,000 Medicare said the hospital could not charge me. That left a balance of $138,000. Medicare allowed $12,000 of that and split that payment between themselves and me.
I am not going to speak specific deductible numbers because I can not remember them. ( I don't have to present them to prospects 40 times a day.) Part A deductibles are larger than the Part B deductible.
IF I had had a large employer EGH plan from active employment in place, Medicare would have subtracted the EGH plan payments from their allowed amounts. You can look at the numbers above and make your own speculations on what an EGH plan might have paid and what the deduction from the Medicare allowed amounts might have been had I been an admitted patient. My uninformed personal opinion is that the final Medicare allowed amount would not have been a very large share of $12K.
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I am not an agent. I am a Medicare Beneficiary.
Some of the impact may depend on the Employer's EGH carrier. Some carriers may chose to process the retired spouse's claim under the Large Employer's group health coverage from active employment as though the carrier's liability is secondary to Medicare. In the absence of a Medicare EOB, they may create assumed Medicare "primary payer" allowed amounts to calculate their own COB based liability.
This is a rather unpleasant situation to have to cope with.
@LostDollar , EGH (primary) + Medicare A = Part A might pay after EGH. In 2019 Rachel had a 4 day hospital stay. Her coverage was EGH (primary), Part A (secondary) . . . Part A paid 6% of the hospital bill.
EGH + Part B = Part B often pays $0.
EGH + Part B = Part B often pays $0.
Why?
Enrolling in Medicare Part A Hospital insurance that covers inpatient care, skilled nursing facility care, and some home health care does impact employer-sponsored health insurance, but how it interacts depends on the specifics of your employment situation:
- Employer Size:
- If the employer has fewer than 20 employees, Medicare pays first, and the group health plan pays second.
- If the employer has 20 or more employees, the group health plan pays first, and Medicare pays second.
- Coordination of Benefits:
- Medicare becomes a secondary payer if the group health plan covers you and the employer meets the thresholds above. This means Medicare covers costs after the primary insurance handles its portion.
- Retiree Coverage:
- If you're retired and have retiree health coverage (not employer coverage), Medicare typically pays first during periods where you're eligible.
- Drug Coverage Impact:
- Adding Medicare drug coverage (Part D) can lead to losing employer-sponsored health benefits for you and your dependents. Always involve the organization's benefits administrator before enrollment.
- Adding Medicare drug coverage (Part D) can lead to losing employer-sponsored health benefits for you and your dependents. Always involve the organization's benefits administrator before enrollment.
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