Roadmap to Medicare Under 20 Employees

Roadmap to Medicare

Group Health Plan, Under 20 Employees

More information on:

Your Roadmap is based on…

Your Primary Insured intends to remain actively working (at the employer providing your benefits)
You are covered under the group health insurance plan
The employer providing health insurance has less than 20 employees

Recommendation Summary:

- Once you become Medicare eligible, your Group Health Insurance will become secondary and Medicare will become the Primary Insurance.
- In order to maintain full insurance coverage, we recommend that you enroll in both Part A and Part B during your Initial Enrollment period.
- Schedule your Roadmap to Medicare appointment with an HTA Medicare Advisor if you have not done so already.
- How to Enroll in Medicare Part A and Part B at age 65
- How to Enroll in Medicare Part A and Part B if you are over age 65 and missed your Initial Enrollment Period

What is my deadline to enroll?

Your Initial Enrollment Period (Turning 65) is 7 months surrounding your 65th birthday to enroll online. If you do not enroll during that time, you can enroll anytime up to 8 months after your group coverage or the employment that it is based on ends (Over Age 65). Although you are not under an immediate enrollment deadline, you still need Medicare for full coverage (see section below).

Do I need Medicare to have full coverage?

Yes. Medicare Who Pays First states that since the employer who you get your insurance through has less than 20 employees, Medicare becomes the primary insurance once you turn 65. If you do not enroll in Medicare, you may not have full coverage.

Will I receive a penalty if I don’t enroll now?

No. You will not receive a late enrollment penalty provided you remain covered under the group creditable coverage and your primary insured remains actively at work at the employer that provides your benefits. Although you will not receive a penalty with creditable coverage, you still need Medicare A&B for full coverage (see section above).

Secondary Insurance Options

Since your group health benefits are likely considered secondary insurance to Medicare, you MUST be enrolled in Medicare A and B to have full coverage. You will have the option to keep your Group Health Plan as secondary or elect a Medicare Supplement and Medicare Prescription Drug Plan as secondary.

Medicare or Group Health?
Does it make sense to drop my group health plan to enroll in Medicare Supplement Insurance and a Medicare Prescription Plan?

A general rule of thumb is that if your group health plan costs on average less than $150-200/month/person or about $2000-2400/year/person, then your group health plan is more cost effective than Medicare.

Please add up the premiums, copays, deductibles and coinsurances (everything except Rx cost) of your current group health plan for comparison.

However, if you think you may pay more than that, or you are seeking lower deductibles and copays, then you may want to explore Medicare further.

Please contact us for a Medicare Cost Analysis to help you better evaluate if your Group Health Plan or a Private Medicare Supplement and Medicare Prescription plan is more cost effective.

If Medicare Secondary coverage is more cost effective than your current plan, you may want to replace your current plan.

If your employer is paying the premium on your current plan, you may want to approach them to see if they would be willing to reimburse you the amount they are currently paying to your insurance to help you pay for Medicare instead.

Additional Considerations
Underwriting Considerations:

Medicare Supplement Insurance has an Open Enrollment Period for the first 6 months that you are enrolled in Medicare Part B. During this time, you will be able to purchase ANY medicare supplement plan with no medical underwriting.

If you stay with your group health plan and decide to elect a Medicare Supplement later (when group health ends, but you have already been on Medicare for more than 6 months) you will have SOME plans available on a Guaranteed Issue basis. There will be less options available that do not require you to answer medical questions to qualify.

Medicare Advantage Plans and Medicare Prescription Drug Plans provide an Initial Election Period when you enroll in Medicare, a Special Election Period when you come off your group plan, and also allow you to change plans once a year during the Annual Election Period (October 15^th through December 7^th) without medical underwriting.

Spouse Under Age 65-  If your spouse relies on your group health plan for benefits, please be mindful that if you come off your group plan, your spouse will have to go on COBRA, seek benefits through their respective employer, or purchase individual health insurance until they become Medicare eligible.

Effective Date Considerations- Reminder, when you apply for Medicare at age 65, you cannot choose a specific effective date for the benefits (and premiums) to start. The only way to influence the effective date is by which month you enroll online.  Please contact us ASAP if you are trying to achieve a specific start date that is something other than the first of the month of your 65th birthday (possibly to coordinate with your group plan ending).

Important HSA Considerations– You cannot continue to contribute to your Health Savings Account (HSA) once you enroll in Medicare Part A. If you are enrolling in Medicare after age 65, your Part A effective date may be back dated up to 6 months. Please contact us to discuss the HSA maximum contribution rate for you circumstances.  Click Here for Details and Rules.

This does not apply to Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA). Medicare does not have any restrictions on these types of accounts.