Medicare and Employer Coverage

Medicare Insurance

Medicare and Employer Coverage:
Understanding Your Options

When it comes to healthcare coverage, there are a lot of options out there. If you’re approaching retirement age, you might be wondering how Medicare and employer coverage fit into the picture. Understanding your options can be daunting, but it’s important to know what you’re eligible for and what each option covers.
In this article, we’ll take a deep dive into Medicare and employer coverage, including what they are, how they differ, and what you need to know when it comes to making a decision about your healthcare coverage.

What is Medicare?

Medicare is a federal health insurance program that’s available to people who are 65 or older, people with certain disabilities, and people with End-Stage Renal Disease (ESRD). It’s divided into several different parts, each of which covers different healthcare services:

Medicare Part A

Medicare Part A covers hospital stays, skilled nursing facility care, hospice care, and some home health care services.

Medicare Part B

Medicare Part B covers doctor visits, outpatient care, preventive services, and some medical equipment and supplies.

Medicare Part C

Medicare Part C, also known as Medicare Advantage, is an alternative to Original Medicare (Part A and Part B) that’s offered by private insurance companies. Medicare Advantage plans typically include prescription drug coverage and additional benefits that Original Medicare doesn’t cover, like dental and vision care.

Medicare Part D

Medicare Part D covers prescription drugs.

What is Employer Coverage?

Employer coverage is health insurance that’s offered through your employer or your spouse’s employer. If you’re still working and you have employer coverage, you might be wondering how it fits in with Medicare.

How Does Employer Coverage Work with Medicare?

If you have employer coverage and you’re eligible for Medicare, you’ll need to decide whether to keep your employer coverage or enroll in Medicare. Here are a few things to consider:
  • If you have employer coverage through your own or your spouse’s employer and the employer has more than 20 employees, your employer coverage is considered primary and Medicare is secondary. That means your employer coverage pays first, and Medicare pays second.
  • If you have employer coverage through your own or your spouse’s employer and the employer has fewer than 20 employees, Medicare is considered primary and your employer coverage is secondary. That means Medicare pays first, and your employer coverage pays second.
  • If you’re still working and you have employer coverage, you can delay enrolling in Medicare without penalty until you retire. At that point, you’ll have a special enrollment period to sign up for Medicare.
  • If you have retiree coverage through your former employer, it’s important to know that retiree coverage is not the same as employer coverage. Retiree coverage is typically secondary to Medicare, and you’ll need to enroll in both Medicare and retiree coverage to have comprehensive coverage.
  • How to Choose Between Medicare and Employer Coverage

    Coverage: Evaluate what each plan covers and make sure it meets your specific healthcare needs. For example, if you have a chronic condition that requires frequent doctor visits or expensive medication, make sure the plan you choose covers those services.

    Cost: Compare the costs of each plan, including premiums, deductibles, copays, and coinsurance. Keep in mind that Medicare and employer coverage have different cost structures, so make sure you understand how each plan works.

    Provider network: Check if your preferred doctors and hospitals are in the plan’s network. If you have a doctor or hospital that you prefer to go to, make sure they’re covered by the plan you choose.

    Flexibility: Consider how much flexibility each plan offers. Some plans may have more restrictions on which providers you can see or which services are covered, while others may offer more flexibility.

    Future needs: Think about your future healthcare needs. If you’re in good health now but anticipate needing more healthcare services in the future, make sure the plan you choose will meet those needs.

    How to Enroll in Medicare

    If you’re eligible for Medicare and decide to enroll, here’s how to get started:
  • If you’re already receiving Social Security benefits, you’ll automatically be enrolled in Medicare Parts A and B when you turn 65. You’ll receive a Medicare card in the mail about three months before your 65th birthday.
  • If you’re not receiving Social Security benefits, you’ll need to enroll in Medicare yourself. You can do this online, by phone, or in person at your local Social Security office.
  • If you’re interested in Medicare Advantage (Part C) or Medicare prescription drug coverage (Part D), you can enroll in those plans during your initial enrollment period or during the annual enrollment period (October 15 to December 7 each year).
  • How to Make Changes to Your Medicare Coverage

    If you’re already enrolled in Medicare and want to make changes to your coverage, here are some options:
    During the annual enrollment period (October 15 to December 7 each year), you can make changes to your Medicare Advantage or Medicare prescription drug coverage.
    During the Medicare Advantage open enrollment period (January 1 to March 31 each year), you can switch from one Medicare Advantage plan to another or switch from Medicare Advantage back to Original Medicare.
    If you have a Medicare Advantage plan, you can make changes to your plan during a special enrollment period if you experience certain life events, like moving to a new area or losing your employer coverage.


    Choosing between Medicare and employer coverage can be a complex decision, but understanding your options and evaluating your needs can help you make the right choice. Whether you choose Medicare, employer coverage, or a combination of the two, make sure you understand the costs, coverage, and provider network for each plan. And remember, if you have questions or need help, there are resources available to assist you in making an informed decision about your healthcare coverage.

    Frequently Asked Questions

    Q: Can I have both Medicare and employer coverage?
    A: Yes, you can have both Medicare and employer coverage. If you’re still working and you have employer coverage, you can delay enrolling in Medicare until you retire.

    Q: How much does Medicare cost?
    A: The cost of Medicare varies depending on the parts you’re enrolled in and your income. Most people don’t pay a premium for Medicare Part A, but there are premiums for Part B and Part D. You can find more information about Medicare costs on the Medicare website.

    Q: Can I switch from Medicare to employer coverage or vice versa?
    A: Yes, you can switch from