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Medicare Part A and spouse's employer-provided health insurance

I'm 65 and retired, but covered under the group plan provided by my wife's employer (a company with more than 20 employees). I know I can delay enrollment in Part B without penalty while still covered by her plan, but I'm wondering if there would be any advantage (or disadvantage) in signing up for Medicare Part A right now. If I'm hospitalized, would Part A serve as secondary coverage, and pay for costs not covered by my primary insurance (deductible and copay) that exceed the Medicare deductible?

 

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Honored Social Butterfly

If you have Medicare Part A and you also have a group health plan coverage based on your current employment (or the current employment of a spouse of any age), and the employer has 20 or more employees, the group health plan generally pays first.  You should check with the Company HR Dept to make sure.

 

If you have a Hospital claim and the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment. Medicare will pay based on what the group health plan paid, what the group health plan allowed, and what the doctor or health care provider charged on the claim. You'll have to pay any costs Medicare or the group health plan doesn't cover.

 

Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer employees under 65. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.

 

Medicare.gov - Which Insurance Pays First

 

The ONLY reason for NOT signing up for Medicare Part A when you have employer group coverage is if you want to continue an HSA And want to continue contributions to it.  HSA type coverage DOES NOT work at all with Medicare - any part of it.  You can use what might be in the account but no more contributions to it once you go on Medicare - any part of it.

 

It's Always Something . . . . Roseanna Roseannadanna

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If I'm hospitalized, would Part A serve as secondary coverage, and pay for costs not covered by my primary insurance (deductible and copay) that exceed the Medicare deductible?

 

Not necessarily.

 

Medicare secondary to an employer group plan falls under COB provisions. With MSP is rare for them to pay anything at all.

 

https://www.medicare.gov/Pubs/pdf/11546-coordination-of-benefits.pdf

 

https://www.medicare.gov/Pubs/pdf/02179-medicare-coordination-benefits-payer.pdf

 

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Reco...


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Honored Social Butterfly

If you have Medicare Part A and you also have a group health plan coverage based on your current employment (or the current employment of a spouse of any age), and the employer has 20 or more employees, the group health plan generally pays first.  You should check with the Company HR Dept to make sure.

 

If you have a Hospital claim and the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment. Medicare will pay based on what the group health plan paid, what the group health plan allowed, and what the doctor or health care provider charged on the claim. You'll have to pay any costs Medicare or the group health plan doesn't cover.

 

Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer employees under 65. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.

 

Medicare.gov - Which Insurance Pays First

 

The ONLY reason for NOT signing up for Medicare Part A when you have employer group coverage is if you want to continue an HSA And want to continue contributions to it.  HSA type coverage DOES NOT work at all with Medicare - any part of it.  You can use what might be in the account but no more contributions to it once you go on Medicare - any part of it.

 

It's Always Something . . . . Roseanna Roseannadanna
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Thanks GailL1, for the quick and comprehensive response.
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