Medicare Insurance

SHOULD I GET PART B

If you or your spouse (or family member if you're disabled) are still working and you have insurance through that employer or union, contact your employer or union benefits administrator to find out how your insurance works with Medicare. This includes federal or state employment, but not military service (unless on active duty). It may be to your advantage to delay Part B enrollment.

 

Note: You can sign up for Part B without a penalty any time you have health coverage based on current employment.

(COBRA and retiree health coverage don't count as current employer coverage.)

When employer/union coverage ends

Once your employment (or your employer/union coverage) ends, 3 things happen:

 

You may be able to get COBRA coverage, which continues your health insurance through the employer's plan (in most cases for only 18 months) and probably at a higher cost to you.

You have 8 months to sign up for Part B without a penalty, whether or not you choose COBRA. To sign up for Part B while you're employed or during the 8 months after employment ends, complete an Application for Enrollment in Part B (CMS-40B) and a Request for Employment Information (CMS-L564). If you choose COBRA, don't wait until your COBRA ends to enroll in Part B.

 

If you don't enroll in Part B during the 8 months after the employment ends:

You may have to pay a penalty for as long as you have Part B. You won't be able to enroll until January 1–March 31, and you'll have to wait until July 1 of that year before your coverage begins. This may cause a gap in health care coverage.

If you already have COBRA coverage when you enroll in Medicare, your COBRA will probably end. If you become eligible for COBRA coverage after you're already enrolled in Medicare, you must be allowed to take the COBRA coverage. It will always be secondary to Medicare (unless you have End-Stage Renal Disease (ESRD)). Learn more about how Medicare works with other insurance.

I HAVE EMPLOYER COVERAGE

Even if you have coverage through a current or former employer, you still may need to make some important Medicare enrollment decisions. You may have to pay a penalty if you don't enroll on time, so it's best to understand how your current coverage works with Medicare before making any decisions.

 

I HAVE EMPLOYER COVERAGE AND I'M TURNING 65

If you (or your spouse) are currently working, and you're covered by an employer or union group health plan based on that employment, ask your employer or union benefits administrator if they require you to sign up for Medicare. If the employer doesn't require you to sign up for Medicare right away, you can sign up later during a Special Enrollment Period without a late enrollment penalty.

I'M OVER 65

If you (or your spouse) are working, and you're covered by an employer or union group health plan based on that employment, you don't need to do anything until you (or your spouse) retire or you lose the coverage.

 

After you (or your spouse) retire, you'll be able to sign up for Medicare during a Special Enrollment Period without a late enrollment penalty.

I HAVE RETIREE OR COBRA COVERAGE

If you have retiree health insurance from a former employer or union, or you have COBRA, Medicare will become your primary health insurance once you sign up. Medicare will pay its part of the costs for any health care services you get, and then you can submit any amount not covered by Medicare to your employer's plan.

 

If you don't sign up for Medicare when you're first eligible, your current coverage might not pay your medical costs during any period in which you were eligible for Medicare but didn't sign up for it. You may need to have both Part A and Part B to get full benefits from this coverage. You're also not eligible to sign up for Medicare through a Special Enrollment Period when this coverage ends.

 

If you have questions about your current insurance, the best source of information is your benefits administrator, insurer, or plan provider.

HOW MUCH DOES PART B COST?

PART B PREMIUMS

You pay a premium each month for Part B. If you get Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment.

If you don’t get these benefit payments, you’ll get a bill.

Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.

 

The standard Part B premium amount is $121.80 (or higher depending on your income). However, most people who get Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015. This is because there wasn't a cost-of-living increase for 2016 Social Security benefits.

You'll pay a different premium amount if:

  • You enroll in Part B for the first time in 2016.

  • You don't get Social Security benefits.

  • You're directly billed for your Part B premiums.

  • You have Medicare and Medicaid, and Medicaid pays your premiums. (Your state will pay the standard premium amount of $121.80.)

  • Your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount.

If you're in 1 of these 5 groups, here's what you'll pay:

If your yearly income in 2014 (for what you pay in 2016) was       

MEDICARE & GROUP HEALTH - WHO PAYS FIRST?

If the employer has more than 20 employees, the group health plan generally pays first.

 

If the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment. Medicare will look at what your group health plan paid, and pay any additional costs up to the Medicare-approved amount for Medicare-covered and otherwise reimbursable items and services.

 

Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer younger employees. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.

This information taken in entirety from Medicare.gov

Get more information about your Part B premium from Social Security.

 

Part B deductible & coinsurance

You pay $166 per year for your Part B deductible. After your deductible is met, you typically pay 20% of the Medicare-approved amount for most doctor services (including most doctor services while you're a hospital inpatient), outpatient therapy, and durable medical equipment.

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