How Medicare And Employer Coverage Works

While it’s possible to have Medicare and private health insurance simultaneously, there are several things to consider to ensure you have the right coverage level.

Talking to an experienced health insurance agent specializing in North Carolina Medicare can help. We can review the cost of Medicare compared to your copays and deductibles under your group coverage. Knowing these details can help us determine whether it’s best to stay with your employer coverage, enroll in Medicare, or choose both. 

Can I have both employer insurance and Medicare?

If you’re turning 65 and working for an employer that offers employer-sponsored insurance coverage, you can keep this coverage even if you enroll in Medicare. The same rule applies if you have coverage under your spouse’s employer group health coverage. As a result, your Medicare benefits can work with your existing coverage. How it works depends on the size of your employer.  

If you work for an employer with over 20 employees, then your employer coverage is your primary coverage, while Medicare is secondary. Your group plan will pay first, and your Medicare will pay second for your healthcare costs. 

If you work for a small employer with under 20 staff members, Medicare will become your primary insurance coverage, and your employer coverage will be secondary. Medicare will pay first, so you must enroll in Medicare Part A and B. 

Most people in North Carolina with group coverage enroll in Medicare Part A when they reach 65. Medicare Part A is premium-free for anyone who has worked for at least 10 years in the US and helps pay for hospital care and inpatient services.

Medicare Part B relates to outpatient services and involves paying a monthly premium based on how much you earn. You can delay enrolling in Medicare Part B and Part D to save on premiums if your employer coverage already contains benefits for outpatient services. If you delay enrollment because of employer group coverage, you can enroll later without facing late penalties. You’ll need to enroll within eight months of your group coverage ending.

Selecting Medicare as your primary health insurance

Depending on your circumstances, leaving your group health insurance plan and selecting Medicare as your primary coverage may be more beneficial. You should consider adding a Medigap plan to help ensure you have the coverage you need. This option may be more cost-effective for you (or your spouse), helping to reduce your deductible spending and remove copays for your doctor visits. 

At Health Plans of NC, our Medicare agents can help determine the right option for you. We’ll consider how much your plan deductible is, your copay amounts, and your requirements for prescription drug coverage. We must also understand how your employer coverage affects your payroll deductions. 

How Medicare works with health savings accounts

If you have a health savings account (HSA) and enroll in Medicare, you and your employer will no longer be able to contribute to your HSA.

This exemption also applies if your employer has less than 20 employees and you need to enroll in Parts A and B. If your spouse has coverage under your employer’s group plan and isn’t registered for Medicare, they can continue to contribute to your HSA.  SEE ALSO: How Can Early Retirement Impact Health Insurance?, How Medicare Agents Get Paid, How Medicare And Employer Coverage Works, When & How to Tell Your Insurer About Life Changes

Get help from a Medicare agent

Enrolling in Medicare when you’ve got employer health insurance doesn’t have to be complicated. Contact one of our local Medicare agents based in various locations throughout North Carolina. We often get asked questions like ‘Can you have a Medicare Advantage plan and employer insurance?’ or ‘Can I have employer health insurance and Medicare’? Our agents can help answer all your questions and get the right health coverage for you and your family. Contact us today or compare plans online.