🇺🇸 A trusted non-government website. Here's how you know.
716.833.0252
Who Pays First When I Have Medicare And Insurance From My Employer Living In WNY?
By Andrew L Hibbard @WNYMrMedicare
Originally Posted: 19 JUNE 2023
Updated & Revised:
Long gone are the days of age 65 being the planned retirement age for many, if not most, Baby Boomers in Buffalo born after 1957.
You are likely in this same, or similar situation as your same-aged peers, which has become more and more common these days, seeing the mass majority continuing to work past age 65, kicking the can down the retirement road until you have met the arbitrary and government assigned “full-retirement age.”
This creates a real concern and confusion having to cobble-together your coordination of coverage, with many folks feeling forced to figure out all the fine print on their own, stressed and scared they don’t make a major mistake, or mess anything up.
That’s not fair…or your fault!
First things first, if you plan to keep working past age 65, either by choice (‘cause you love your job), or by circumstance (‘cause you need the money), the BIG question is do you need to sign up for Medicare if you can keep your health insurance at work?
For most people, in most situations, Medicare seems to be the more financially favorable health insurance coverage choice over and above choosing to continue insurance coverage through an employer. (To confirm what makes the most sense for you specifically, I couldn’t say for sure until we get together, you share your situation, and we crunch the numbers. You can schedule a free strategy session with me by clicking HERE).
For the sake of this SmartStart Answers article, let’s assume you DO need to sign up for Medicare, and, you will also choose to keep your Employer Group Health Plan (EGHP), so a good, smart, question which most people never know, or think to ask is this...
WHO PAYS FIRST WHEN I HAVE MEDICARE AND INSURANCE FROM MY EMPLOYER?
Let me explain…
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.
There are two common situations you may find yourself in which will require a coordination of coverage when you have both Medicare and health insurance from your employer. There are these…
(SITUATION 1)
You Will Have Medicare Plus Employer Health Insurance At An Employer With More Than 20+ Employees
When you sign up for Medicare, and you will stay insured through your Employer Group Health Plan (EGHP) with more than 20 employess, 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)
You Will Have Medicare Plus Employer Health Insurance At An Employer With Less Than 20 Employees
When you sign up for Medicare, and you will stay insured through your Employer Group Health Plan (EGHP) with less than 20 employees, 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.
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!
You Can Feel Confident Knowing What To Do With Medicare.
I Can Take Away The Stress Of Trying To Tackle It On Your Own.
Figuring out all the fine print with Medicare doesn't need to feel stressful. You don't have to spend your scarce free time at home, alone, in isolation, relying on your own assumptions and hit-or-miss guesses, attempting to do-it-yourself.
Confidently knowing exactly what to do (and when) with Medicare is the key to avoiding future fines and fees and only my Medicare SmartStart Program will show you how.
If you don't have the time or the desire to deal with Medicare directly, and want a BETTER, SMARTER, time-saving solution to short-cut hours of your own trial and error so you know --- without question --- you aren't messing anything up making a mistake...
Let me put my proven Medicare SmartStart Program to work for you.
Click the link below to take the next step and schedule a complimentary Medicare SmartStart Strategy Session with me --- it's that easy!
You Can Feel Confident Knowing What To Do With Medicare.
I Can Take Away The Stress Of Trying To Tackle It On Your Own.
Figuring out all the fine print with Medicare doesn't need to feel stressful. You don't have to spend your scarce free time at home, alone, in isolation, relying on your own assumptions and hit-or-miss guesses, attempting to do-it-yourself.
Confidently knowing exactly what to do (and when) with Medicare is the key to avoiding future fines and fees and only my Medicare SmartStart Program will show you how.
If you don't have the time or the desire to deal with Medicare directly, and want a BETTER, SMARTER, time-saving solution to short-cut hours of your own trial and error so you know --- without question --- you aren't messing anything up making a mistake...
Let me put my proven Medicare SmartStart Program to work for you.
Click the link below to take the next step and schedule a complimentary Medicare SmartStart Strategy Session with me --- it's that easy!
Get Started For FREE!
Who Is Andrew Hibbard?
Since 2015, Andrew has helped over 850+ Western New Yorkers through his nationally recognized Medicare SmartStart Program, taking away all the stress from folks trying to tackle Medicare on their own. His impressive record of success has been gotten Andrew featured in Forever Young Magazine and the BEE Group Newspapers, exclusive interviews on WECK Radio's Senior Matter's Program, and author an #1 Amazon best-selling guidebook on the subject, "Starting Medicare Smartly," revealing how the rules specifically and significantly differ for NY residents versus other states.
- 716.833.0252
Copyright 2015-2022. www.WNYmedicare.org
All Rights Reserved.