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Health April 2012

Navigating Medicare: A Toolkit to Find Answers

By Teresa Ambord

The Medicare Rights Center in collaboration with other industry experts has put together a toolkit to help you find answers for those who are Medicare eligible but not yet signed up. It also provides information for those who become eligible while still covered by an employer plan, or a union plan.

If the rocky economy has you rethinking retirement, you may also be wondering whether or not you should enroll in Medicare. The leading edge of baby boomers turned 65 in 2011, but many of you may have decided to remain in the workforce a little bit longer. If you do and you are covered by your employer’s health insurance plan, how will that affect your Medicare? Will the two plans conflict, and which one pays first? Should you wait to enroll?

These questions are important to answer, but even many human resource professionals are not equipped with the information you will need. The Medicare Rights Center, in collaboration with a group known as AgeOptions and the help of The Retirement Research Foundation, has put together a toolkit to help you find answers for those who are Medicare eligible but not yet signed up. It also provides information for those who become eligible while still covered by an employer plan, or a union plan. The toolkit is called “How Medicare Works With Employer-Based Insurance: A Guide for Employers, Professionals and Consumers.” You can find in PDF form by logging onto:

What’s in the online toolkit? It starts with a primer in the form of a slide presentation on the nuts and bolts of what Medicare is, eligibility requirements, and how to enroll, whether or not you have other coverage. If you are a human resources professional this slide show, labeled “Medicare and Employer Benefits Training – The Basics” provides basic information that, although appropriate for layman, can also help you understand the system so you can assist others.

The next section is specifically addressed to those of you entrusted with having the answers. It’s called “Medicare and Employer Benefits Professional Training.” This is also a slide presentation to add further training to those who work with Medicare beneficiaries. It addresses issues of how Medicare coordinates with employer coverage, COBRA, retiree coverage, and plans of various sizes. It warns readers about the consequences of late enrollment, and gives specific guidance about using Medicare Part B.

Like most well-crafted online resources, the toolkit includes a section where miscellaneous questions are answered. Here are a few of the “Frequently Asked Questions,” one from each subdivision in the toolkit.


General Questions

Q. Do I have to pay for Medicare?

A. Part A is free if you or your spouse has worked and paid taxes to Medicare for at least 40 quarters (10 years). If you do not have enough working quarters, you will have to pay a premium for Part A. Part B always has a monthly premium. If you have a Medigap or Part D plan you may have to pay a monthly premium for these as well. Keep in mind that Medicare Advantage plans have different costs than original Medicare. If you have a low income, you may qualify for programs that can help pay your Medicare premiums and other costs.


Current Employer Insurance

Q. What happens if I drop my employer insurance?

A. If you choose to drop your current employer insurance and you already have Medicare, Medicare will become your primary insurance. If you do not have Medicare and drop your employer insurance, enroll in Part B before your employer coverage ends to avoid any gaps in your coverage.


Retiree Insurance Questions

Q. I have Medicare. Do I need to keep my retiree insurance?

A. Whether you keep your retiree insurance is up to you. Retiree insurance can act as supplemental insurance to Medicare. This means that it may pay out-of-pocket costs that Medicare does not pay for. It may also cover things that Medicare does not cover such as routine vision or dental care. Remember, you are responsible for paying your Medicare premiums as well as your retiree plan’s premiums.


COBRA Questions

COBRA is a federal law that allows certain employees, their spouses and dependents to keep their group health plan for between 18 and 36 months after they leave their job or lose coverage for certain other reasons. COBRA is always secondary to Medicare. If you have COBRA and Medicare, you should consider whether continuing with COBRA is worth the expense. If you have dependents covered by your COBRA plan you should consider how their coverage will be affected if you lose or drop your COBRA.


Q. Can I have both COBRA and Medicare?

A. Whether you can have COBRA and Medicare depends on which one you had first. If you have COBRA and then become eligible for Medicare, your COBRA may end. If you have Medicare and then become eligible for COBRA, you can sign up for COBRA insurance and it will be secondary to Medicare.

If you’ve read through the FAQ and your questions are still not answered, the toolkit provides a set of individual scenarios that start with a consumer question describing a situation, and then gives a step-by-step explanation of how Medicare might apply. Scenarios include Current Employer Insurance, Current Employer for People with Disabilities, Retiree Insurance, and COBRA. Browse through the scenarios and you may find one that clarifies the information you need to know.


Medicare Part B

Medicare Part B is a subject that inspires a lot of questions. That’s why the toolkit offers an area that delves more deeply into your questions about enrollment in Medicare Part B, whether or not to decline, and equitable relief.

Does It All Sound like Greek to You?

Finally if you feel like the language of Medicare is just not clear and you feel like they are speaking another language, check out the Glossary of Terms. This is your Medicare dictionary that should help you navigate the waters as you decide what action to take regarding enrollment.


Teresa Ambord is a former accountant and Enrolled Agent with the IRS. Now she writes full time from her home, mostly for business, and about family when the inspiration strikes.

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