What does Medicare A do, if one is still working with health coverage?

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ResearchMed
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What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

We each signed up for Medicare A when we each turned 65, although we still had employer health benefits. We did not have to pay anything for A, etc.

But... what does Medicare A "do", while one still has regular health insurance?
What do we get? Or what does Employer get?

I was in hospital last December. Did Medicare A reimburse our health insurer (which self-paid by employer) for some of the hospital charges?

Or...?

RM
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Flyer24 »

Topic moved to Personal Finance (insurance).
tj
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Re: What does Medicare A do, if one is still working with health coverage?

Post by tj »

If Medicare paid anything, you would think they would send you an EOB.
MathWizard
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Re: What does Medicare A do, if one is still working with health coverage?

Post by MathWizard »

Typical employers require Medicare to be the primary insurance

You will likely pay less for your employer plan when it in effect a Medigap policy.

For my spouse and I, the health insurance is about $13K per year pre-Medicare, about half that once we both are on Medicare.
tj
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Re: What does Medicare A do, if one is still working with health coverage?

Post by tj »

MathWizard wrote: Thu Sep 10, 2020 10:04 pm Typical employers require Medicare to be the primary insurance

You will likely pay less for your employer plan when it in effect a Medigap policy.

For my spouse and I, the health insurance is about $13K per year pre-Medicare, about half that once we both are on Medicare.
For federal employees, Medicare is secondary until you retire.
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ResearchMed
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Re: What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

MathWizard wrote: Thu Sep 10, 2020 10:04 pm Typical employers require Medicare to be the primary insurance

You will likely pay less for your employer plan when it in effect a Medigap policy.

For my spouse and I, the health insurance is about $13K per year pre-Medicare, about half that once we both are on Medicare.
That won't change, at least for us, until DH retires, and then we will need to start Medicare B.

For now, our health costs are, to us, the same as it was before we each turned 65 (other than for annual changes for all participants). We can't "see" any difference. There is no "with/without Medicsre A" cost structure.

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ResearchMed
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Re: What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

tj wrote: Thu Sep 10, 2020 10:01 pm If Medicare paid anything, you would think they would send you an EOB.
I'd have to look into that, but we didn't pay much attention to that bill, for two reasons:

1) I was very sick for quite some time after discharge, so a lot of non-essential paperwork got set aside;
and

2) I had already reached my annual Out Of Pocket (OOP) maximum before the hospital stay, so as long as al of the charges were covered (and they were), there would be nothing for me to pay. No deductible, no co-payment, etc.

So IF Employer/insurer (who only administers the plan; Employer pays) got reimbursed, we wouldn't have any way to see it, as the balance due from me was zero no matter what.

RM
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MathIsMyWayr
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Re: What does Medicare A do, if one is still working with health coverage?

Post by MathIsMyWayr »

ResearchMed wrote: Thu Sep 10, 2020 10:15 pm
MathWizard wrote: Thu Sep 10, 2020 10:04 pm Typical employers require Medicare to be the primary insurance

You will likely pay less for your employer plan when it in effect a Medigap policy.

For my spouse and I, the health insurance is about $13K per year pre-Medicare, about half that once we both are on Medicare.
That won't change, at least for us, until DH retires, and then we will need to start Medicare B.

For now, our health costs are, to us, the same as it was before we each turned 65 (other than for annual changes for all participants). We can't "see" any difference. There is no "with/without Medicsre A" cost structure.

RM
Whether Medicare is primary or secondary depends on the size of the employer. Large employer's insurances are primary. It looks like MathWizard's employer is small.
Big Dog
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Big Dog »

tj wrote: Thu Sep 10, 2020 10:01 pm If Medicare paid anything, you would think they would send you an EOB.
Correct. If Medicare paid anything, you'd eventually receive an EOB from Medicare.
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Katietsu »

Patients with medicare have protections that the rest of us do not have. I suspect, though do not know, that patients with medicare as secondary would still have the benefit of those extra protections against things like surprise billings and fast discharges.
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Spirit Rider »

Medicare is only primary if your employer has < 20 employees, otherwise Medicare is secondary.

This means if you enroll in Medicare Part A and you have an employer policy that has co-pays and/or co-insurance >= 80%, you are unlikely to see Medicare Part A pay anything.

It is especially a bad idea to enroll in Medicare Part A if your employer health insurance policy is an HDHP, because it makes you ineligible for HSA contributions (even by your employer).

Note: If the above is true and you delay enrolling in Medicare Part A until you are no longer on your employer's health insurance plan. You will be automatically retroactively enrolled in Medicare.

This retroactive enrollment will be up to six (6) months, but no earlier than age 65. This will make you retroactively ineligible for HSA contributions by the same amount.
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GerryL
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Re: What does Medicare A do, if one is still working with health coverage?

Post by GerryL »

One thing signing up for Medicare Part A does is make you ineligible to fund an HSA (Health Savings Account) if your employer health insurance is a qualifying high-deductible plan.
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Northern Flicker »

I assume having employment-based health insurance until you enroll in medicare part B and supplement will not lead to having to go through medical underwriting for medicare supplemental insurance, but it is something I would want to verify directly if it were me.
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ResearchMed
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Re: What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

GerryL wrote: Fri Sep 11, 2020 2:29 pm One thing signing up for Medicare Part A does is make you ineligible to fund an HSA (Health Savings Account) if your employer health insurance is a qualifying high-deductible plan.
Thanks.

We don't have health insurance with the features that wouldn't work with Medicare A, and we each signed up for it years ago. Our employer sent us info about Medicare that indicated we should sign up for Medicare A, even though we didn't yet need Medicare B.

I'm just wondering if under an employer self-funded health insurance plan (or not self-self funded?) actually *does* anything, prior to use changing to Medicare (A and B) plus Retiree health insurance coverage from Employer.

Has anyone here on BH actually seen any benefits paid by Medicare Part A, while an employee over age 65 is still covered by Employer's health insurance (as primary)?

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ResearchMed
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Re: What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

Northern Flicker wrote: Fri Sep 11, 2020 2:37 pm I assume having employment-based health insurance until you enroll in medicare part B and supplement will not lead to having to go through medical underwriting for medicare supplemental insurance, but it is something I would want to verify directly if it were me.
Not an issue as long as one has had "Creditable" health insurance from an employer, least in terms of avoiding any penalty for a delayed signup of B.

And we don't need a regular "supplement", as that is automatically the Employer's "Retiree" plan, which is quite good.
(We got grandfathered in to the "best" Retiree plan; younger cohorts have a few lesser options, decreasing in benefits as age cohort gets younger.)

Again, I'm more interested what Plan A *would/could* do in this situation, rather than any restrictions that might be involved.

RM
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runninginvestor
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Re: What does Medicare A do, if one is still working with health coverage?

Post by runninginvestor »

ResearchMed wrote: Fri Sep 11, 2020 2:38 pm
GerryL wrote: Fri Sep 11, 2020 2:29 pm One thing signing up for Medicare Part A does is make you ineligible to fund an HSA (Health Savings Account) if your employer health insurance is a qualifying high-deductible plan.
Thanks.

We don't have health insurance with the features that wouldn't work with Medicare A, and we each signed up for it years ago. Our employer sent us info about Medicare that indicated we should sign up for Medicare A, even though we didn't yet need Medicare B.

I'm just wondering if under an employer self-funded health insurance plan (or not self-self funded?) actually *does* anything, prior to use changing to Medicare (A and B) plus Retiree health insurance coverage from Employer.

Has anyone here on BH actually seen any benefits paid by Medicare Part A, while an employee over age 65 is still covered by Employer's health insurance (as primary)?

RM
I have only seen this in fringe cases where the employer plan had lower cost sharing than Medicare for the given coverage. This is basically to ensure that what the Medicare enrollee is receiving in cost sharing is equal to or greater than what would be provided under Part A.

And as far as covered services, typically if it’s covered by Medicare, commercial insurers cover it (not the other way around though). So that’s another reason why you don’t see Part A picking up a tab if it’s secondary payer.
runninginvestor
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Re: What does Medicare A do, if one is still working with health coverage?

Post by runninginvestor »

ResearchMed wrote: Thu Sep 10, 2020 9:56 pm We each signed up for Medicare A when we each turned 65, although we still had employer health benefits. We did not have to pay anything for A, etc.

But... what does Medicare A "do", while one still has regular health insurance?
What do we get? Or what does Employer get?

I was in hospital last December. Did Medicare A reimburse our health insurer (which self-paid by employer) for some of the hospital charges?

Or...?

RM
You may be able to check if you have an account at Medicare .gov (Medicare website) and seeing if they have had any claims come their way.

In your explanation of coverage/member certificate in your employer plan booklet, it’ll detail how it coordinates benefits with other insurers.
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Spirit Rider »

The two most likely scenarios of Part A paying are where Medicare is primary (>= 20 employees), you are hospitalized and you have:
  • an unmet deductible > the Medicare Part A deductible (2020 = $1408).
  • a co-insurance < 80%. Medicare covered charges are about 80% of average private covered charges.
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ResearchMed
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Re: What does Medicare A do, if one is still working with health coverage?

Post by ResearchMed »

Spirit Rider wrote: Sat Sep 12, 2020 10:09 pm The two most likely scenarios of Part A paying are where Medicare is primary (>= 20 employees), you are hospitalized and you have:
  • an unmet deductible > the Medicare Part A deductible (2020 = $1408).
  • a co-insurance < 80%. Medicare covered charges are about 80% of average private covered charges.
Isn't Medicare primary when there are < 20 employees?

RM
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Spirit Rider
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Re: What does Medicare A do, if one is still working with health coverage?

Post by Spirit Rider »

ResearchMed wrote: Sat Sep 12, 2020 10:43 pm
Spirit Rider wrote: Sat Sep 12, 2020 10:09 pm The two most likely scenarios of Part A paying are where Medicare is primary secondary (>= 20 employees), you are hospitalized and you have:
  • an unmet deductible > the Medicare Part A deductible (2020 = $1408).
  • a co-insurance < 80%. Medicare covered charges are about 80% of average private covered charges.
Isn't Medicare primary when there are < 20 employees? RM
Duh, wrote it exactly backwards
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