By Andrew L Hibbard 

@WNYMrMedicare

Originally Posted: 12 JUNE 2023

Updated & Revised:

As you near age 65, coordinating your health insurance coverage can be a tricky task, especially when Medicare is in the mix. 

More and more common these days, when WNY’ers are turning 65, they are not retiring, rather remain working to allow their Social Security incomes to increase, or in some cases, they have a younger spouse who needs the health insurance until they, too, turn 65.

Does that sound like something you trying to prepare for?

Depending on a handful of factors, Medicare can work smooth and seamless with other health insurance or can be a real pain and problematic.

Here’s what you need to know…

Medical bills are paid based on order of “payer.” Payers are the entities who are responsible for paying. Payers can be Medicare, your Employer Group Health Plan (EGHP) is an active employee, a retiree health insurance plan (if a retired employee), Medicaid (if low-income), and, of course, YOU.

When there is more than on payer involved in payment, it is critically important that an accurate coordination of coverage is in place following the right “coordination of benefits” rules.

These rules and regulations are there to decide and determine which entity is responsible for paying which part of the bill, and the order of who will pay what.

There will always be an entity paying first, or the primary payer. Any remaining bill balance will then be sent the rest and act as the secondary payer. In rarer cases, there may be a third payer.

Here are three common situations you may find yourself in as you near age 65 and are likely to become eligible for Medicare benefits, and asking yourself this question...

HOW DOES MEDICARE WORK WITH MY OTHER HEALTH INSURANCE LIVING IN WNY?

(SITUATION 1)

Turning 65, Will Keep Working, Will Stay Insured Through Employer With More Than 20+ Employees

In this situation you will have to talk with HR and figure out the fine print if the company will require you to sign up for just Medicare Part A, or both Medicare Part A and Medicare Part B, or neither.

Either way, if you do need to sign up for any or all parts of Medicare, and you will stay insured through your Employer Group Health Plan (EGHP), your EGHP will be your primary payer and front the first costs of your medical bills, and Medicare will be your secondary payer --- YOU will pay third and pick up what the other two don’t pay.

(SITUATION 2)

Turning 65, Will Keep Working, Will Stay Insured Through Employer With Less Than 20+ Employees

In this situation you are required to sign up for both Medicare Part A and Medicare Part B, regardless of if you want to or not. (Don’t ask me why, I stopped trying to understand the make-them-up-as-they-go government rules a long time ago).

When you sign up for both Medicare Part A and Medicare Part B and stay insured through your Employer Group Health Plan (EGHP), Medicare will be your primary payer and front the first costs of your medical bills, and your EGHP will be your secondary payer --- YOU will pay third and pick up what the other two don’t pay.

**IMPORTANT NOTE** If you are required to sign up and start both Medicare Part A and Medicare Part B, it would be smart to do a cost comparison between your Employer Group Health Plan (EGHP) and buying a private Medicare plan (Medicare Advantage or Medicare Supplement). In many, if not most cases, it is more financially favorable to forego any EGHP and buy a private Medicare plan instead, and enjoy more coverage for less money.

(SITUATION 3)

Past 65,Working And Now Retiring, Now Need Medicare With A Retiree Healthcare Plan From Former Employer  

In this situation you are required to sign up for both Medicare Part A and Medicare Part B since you will no longer be “actively employed.”

Similar to when you were working, Medicare will be your primary payer and front the first costs of your medical bills, and your EGHP will be your secondary payer --- YOU will pay third and pick up what the other two don’t pay.

Ok, there’s a lot to deal with, right? I get it.

And as an active adult in WNY, who’s always on the run, you need a smart solution to cut through all the clutter. 

If you want some light shed on your situation, your hand held the whole way, and making your move to Medicare simpler, easier, seemingly stress-free and almost effortless, I can do just that. Here's how...

NEARING AGE 65 AND AREN'T SURE WHERE TO START?

**If you are TURNING 65 IN 6-12 MONTHS, my #1 Amazon best-selling guidebook, "Starting Medicare Smartly" will give you a great overview of everything you need to know, before you need to know it. Instead of buying on Amazon for $12.99, click HERE now and let me send you a completely free copy, all at my expense.

**If you are TURNING 65 IN 4-6 MONTHS, you should be getting ready to enroll and your paperwork prepared to either sign up at 65, or suspend --- you can't do nothing. If you don't have the time or desire to deal with doing any of the dirty work with Medicare yourself, OR, you feel frustrated, confused and kind of clueless about figuring out the fine print with Medicare, you can rely on my free Medicare SmartStart Program and let me take away all your stress of trying to tackle anything on your own. It's how I help people just like you. Weekly availability is limited to the first 10 folks, and maximum 40 per month. Don't delay. Click HERE now to learn more about my nationally recognized program, and how you can put it to work for you --- for free.

**If you are TURNING 65 IN 1-4 MONTHS, you are cutting it close to your Medicare late penalty period. If you have NOT yet filled out and filed your Medicare forms, you are behind and against the clock. It is URGENT we get together as soon as possible so I can do all I can, before it's too late, to help you avoid paying a costly late penalty for life. Click HERE now to immediately schedule an emergency Medicare SmartStart Strategy Session with me...if there are any still available.

HAVE MORE MEDICARE QUESTIONS?

Read the most common questions folks in WNY ask when they aren’t sure how to get started with Medicare. Click HERE to see the complete Medicare SmartStart Answers article archive.

ABOUT THE AUTHOR

Andrew L Hibbard is a prominent name when mentioning Medicare in WNY, but one you may have never heard of. Working behind-the-scenes, he is a best-selling author, expert advisor and successful agency owner. Focused on educating first, Andrew prides himself on being considered “the only advocate in WNY fighting for better and more reliable Medicare resources, free from insurance company conflict of interests.”

To take away the stress of trying to tackle Medicare alone and feeling forced to figure it all out by yourself --- Andrew created the WNY Medicare SmartStart Program; a free, step-by-step plan, that holds you by the hand to sign up and start Medicare smartly. (More than 850+ people have gone through the program and call it “the lazy way to get Medicare done for you without costing you a dime”).

**SPECIAL FREE GIFT** If you want to see how hundreds of WNY'ers each year are doing things different with Medicare, and getting it all done in record time, you can request a special "Medicare SmartStarter Info Kit” at no-cost to you, Andrew will give it to you as his free gift. It will prove, without a doubt, why his Medicare SmartStart Program is widely considered the most popular and preferred way to sign up and get started with Medicare in WNY, Guaranteed! Simply click HERE right now, and everything will be rushed to you right away. It's that easy!