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Medicare: Do You Know All You Should?

Your Options to Choose

If you are not working when you turn 65, you can apply for Medicare. However, what happens when a person is still working when they turn 65? If you are working for an employer of 20 or more employees, you can elect to remain covered under your employer's health plan and receive any medical care you need pursuant to the terms and conditions of the employer's policy. If you take this option, you have "elected" your work insurance to be your "primary" coverage. This same rule also applies to spouses who are covered at age 65 under their spouses' work-related health insurance plan.

If you choose this option, you can still elect to receive Medicare. However, your election into Medicare will only enable you to receive benefits under Medicare as "secondary coverage" and only for the limits under the Medicare terms. These benefits are generally not cumulative. For example, if you are forced to stay in the hospital for 92 days, and your policy at work only covers 90 days, and Medicare provisions also cover 90 days, you cannot seek, for this particular visit, the extra 2 days of reimbursement from Medicare on the theory that by having Medicare and your work policy, you actually should receive 180 days [90 days + 90 days = 180 days.]

If you pick Medicare as your "primary coverage," then your employer plan can only pay certain coverages and expenses not covered by Medicare. Your employer coverage cannot pay your deductible, nor can it pay any co-payments which you might owe, as set forth by Medicare.

Legal Issue: Assume that you are a woman who turns 65 while working at a firm which is subject to the federal Medicare rules (20 employees or more) and you have designated your work coverage as the plan which you will use for reimbursement of any medical treatment that you may require. Medicare has recently sent you a letter saying that I cannot apply for Medicare. Is this correct?

Unless there is a state law which overrides this situation, there is most certainly an error. Medicare is still available to you for election, if you choose, as a secondary payor. Medicare must pay certain benefits if they are specified as covered in the Medicare rules.

Legal Issue: Assume you stopped working 10 months ago, but are still covered under your prior company's insurance policy for several more months. You are 65, and you want to apply for Medicare coverage as your "primary" coverage. Can you?

This is a tricky area, because it may involve the COBRA statutes and insurance coverage after work ceases. To answer this question, you should receive professional advice to be completely sure of your own situation. Under the Medicare rules, you must apply for Medicare coverage within 7 months of leaving work or cessation of coverage under your work policy, whichever is sooner. Thus, for this year, if you were to apply after 10 months, you could face two hurdles: (1) higher penalty premiums; and (2) waiting periods or delays.

Medicare: Do You Know All You Should?
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