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Small Company Secondary Insurance

Preparing to enroll in Medicare. I am currently on my spouse's health insurance plan, which I would stay on but the company has less than 20 employees. The plan is a high deductible plan with no monthly premium. Would it be to my advantage to have Medicare as my primary coverage and stay on my spouse's plan for secondary coverage? Thanks in advance.

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Conversationalist

@barn3826 Your first sentence indicates that you aware of enrolling in Medicare due to the less than 20 employees requirement. So, I have interpreted your question differently. Essentially, is it an advantage to stay in your spouse's Plan for secondary coverage or buy a Medicare Supplement Plan for secondary coverage ( also a Medicare Drug Plan)? Or, simply enroll with a Medicare Advantage Plan. In addition to comparing the amount of the High Deductible Plan versus the cost of the Medicare Supplement Plan (including Medicare Drug Plan), you need to review how your spouse's plan coordinates with Medicare Parts A, B, and D. Does that HD Plan have a Non-Duplication provision? For example, if you are hospitalized in 2021, your Part A Hospital deductible is $1,484 (increases each year) for each benefit period. If your spouse's Plan has a $1,500 or more High Deductible, that Plan may pay zero ($0.00) inasmuch as you may not have exceeded the HD deductible. You will pay $1,484. As an alternative to the HD Plan, you may purchase a Medicare Supplement for a monthly premium (varies with insurance company) that will cover  the Part A deductible ($1,484) as well as the Part B deductible ($203) and the  amount that Part B does not pay the physician ( approximately 20% of Medicare determined charges). You will need to ask the HD Plan how the Plan covers prescriptions if Medicare is primary.

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@barn3826If your or your spouse's employer has less than 20 employees and isn't part of a multi-employer or multiple employer group health plan, then Medicare pays first.

 

You have no choice about who is the primary payer . .  . with fewer than 20 employees the primary payer is Medicare, your group insurance plan is secondary.

 

If you do not have Part A or Part B, your group insurance plan pays $0.

 

 


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@barn3826 I don’t think you have a choice  Medicare secondary payer, unless small employer exception.

 

Only you can do the math. Will you save more money with your employer no premium, high deductible plan then eventually adding a 10% penalty for each 12-month period you could’ve had part B to the day you finally sign up for part B.  

 

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