It is essential to correctly transition from employer coverage to Medicare to avoid penalties or a lapse in coverage. In many cases, you should not undertake this change alone. It is vital to work with a Medicare expert who has your best interests in mind.
With so many plans to choose from, comparing your best options is key to enrolling in the right policy. At MWA, we help beneficiaries switch from employer coverage to Medicare. We take pride in knowing our clients are satisfied and confident in their chosen coverage.
Considerations for Eligible Employees
- Understand your options: Before transitioning to Medicare, it’s important to understand the different parts of Medicare (Part A, Part B, Part C, and Part D) and how they work. You should also know the eligibility criteria and enrollment periods for each part.
- Enroll in Medicare: You can enroll in Medicare during your Initial Enrollment Period (IEP), which begins three months before your 65th birthday and ends three months after. If you miss your IEP, you may have to pay a late enrollment penalty. You can enroll in Medicare online, by phone, or in person at your local Social Security office.
- Consider supplemental coverage: Original Medicare (Part A and Part B) does not cover all healthcare costs, so you may want to consider enrolling in a Medicare Supplement Plan (Medigap) to help cover some of the out-of-pocket costs. You may also consider enrolling in a Medicare Advantage plan, which combines Part A, Part B, and sometimes Part D into one plan.
- Review your coverage options: Once you transition to Medicare, you can review your coverage options annually during the Medicare Annual Enrollment Period (AEP) from October 15 to December 7. This is a good time to review your current coverage and make any changes if necessary.
- Keep track of deadlines: Make sure to keep track of important deadlines for enrolling in Medicare and any supplemental coverage. Missing deadlines could result in penalties or gaps in coverage.
If you enroll in Medicare Part A and Part B and you choose to stay on your employer medical coverage, there are important rules to consider.
- If your employer has more than 20 Employees
- Coordination of benefits – group health plan pays claims first, Medicare pays second.
- If your employer has less than 20 Employees
- Coordination of benefits – Medicare pays claims first, group health plan pays second.
- UPMC Health Plan has notified their employer clients who have less than 20 employees, that they will process claims as if Medicare paid first. If the employee is not enrolled in Medicare, they will be responsible for the charges. This is a new policy that started in 2021 that will take effect for all employers upon their renewals.
- Working Medicare beneficiaries can decline group health plan coverage in favor of enrolling in Medicare Parts A, B & D.
- People with incomes higher than $106,000 for individuals and $212,000 for couples pay a progressively higher rate for Part B & Part D.
- Employees cannot contribute to health savings accounts if they are signed up for Medicare.
- Employees in group health plans can enroll in Medicare A & B any time.
- Late enrollment penalties can be charged for Parts B & D unless the member has been covered by theirs or their spouse’s employer coverage.
- Retiree plans, COBRA and ACA individual plans do not count as employer coverage.
Coverage Limitations
- Medicare Parts A, B & D do not cover dental, vision, over-the-counter products, transportation or Silver Sneakers gym memberships.
- Medicare does not cover Long Term Care. There are only 100 lifetime days of nursing home coverage.
Medicare Advantage Plans (Part C)
- Beneficiaries receive their Medicare Parts A, B and usually D benefits through an insurance company.
- These include coverage for dental, vision, over-the-counter products, transportation and Silver Sneakers.
- Depending on the type of plan, members must use the insurance company’s network.
