As you approach the age of 65, you probably are planning ahead for expenses such as health insurance and care costs and weighing the pros and cons of enrolling in Medicare or keeping your employer-sponsored group coverage. The good news is you don’t really have to decide between those health coverage options. You can enroll in Original Medicare during your initial enrollment period and keep your employer coverage. In fact, it may actually save you money to do so. Here are the frequently asked questions we hear all the time:

Medicare and Employer Insurance: What insurance pays first?

If you have Original Medicare (Parts A and B) and employer-sponsored coverage, your two insurances become primary and secondary payers for your claims in a rule called Coordination of Benefits.

What is coordination of benefits? 

Coordination of benefits provides you with more coverage protection. If Medicare is your secondary payer, it may cover additional costs that your employer’s coverage does not; however, it is not guaranteed that Medicare will pay all additional costs. Whether Medicare is your primary or secondary payer depends on the 20-person rule. 

What is the 20-person rule? 

If your employer has fewer than 20 employees, Medicare will be your primary payer and your employee insurance will be your secondary payer. If you decline Medicare when you’re first eligible, it could expose you to additional costs when you do enroll. If your employer has over 20 employees, Medicare will be the secondary payer. You won’t have a penalty for declining Original Medicare during your IEP — as long as you sign up during your special enrollment period when you retire or lose group coverage.

If you’re weighing the pros and cons of enrolling in Medicare, reach out to SmartConnect and we can help you make the right decision for you.