Q: I recently applied for my Medicare benefits and soon after received a form to complete asking for information about employer’s health plans that I might be entitled to. Why would Medicare need such information?
A: Medicare needs to know about other health care coverage in order to establish your benefits file and to determine whether Medicare will be your primary coverage.
Usually when a person becomes eligible, Medicare serves as the primary health care payer. However, some people are entitled to other health care insurance, which preempts Medicare as the primary health care provider and shifts Medicare’s role to that of secondary payer.
The questionnaire you received asks if you have health care coverage under an employer’s health plan either through your or your spouse’s current employment. This initial enrollment questionnaire provides information for the establishment of your Medicare benefit file. Medicare needs to determine if they will be the primary or secondary payer for your health care costs. Without this information Medicare would not be able to pay your claims in a timely manner and you could possibly be billed by your providers for services rendered.
If your or your spouse’s employer coverage is through an HMO you must also provide this information to that HMO. They will then coordinate payments between Medicare and the employer plan.
If you are 65 or older and continue to work or have a spouse who works, federal law protects you from discrimination in employer health care coverage. An employer of 20 or more employees who offers health care benefits must offer you and your spouse the same health care benefits under the same conditions as those offered to other employees.
You have the choice of accepting or rejecting the plan offered by your or your spouse’s employer. If you accept the plan it will be your primary health care coverage as long as you or your spouse continues that employment. Medicare, if you decide to enroll, would then become your secondary insurance and could assist with payment of Medicare-covered services that are not covered under the employer plan.
If you decide to reject the employer’s plan then Medicare will be your primary plan.
It is very important that you let your health care providers know what plan is providing your primary coverage. If it is an employer’s plan providers of care will need the name and address of the employer’s plan and policy number. Providers should be instructed to bill that plan first for any services received.
As soon as you are no longer covered by an employer’s plan it is important that you enroll in Medicare Part B (Medical Coverage), if you have not previously done so. You should also notify the insurance carrier or HMO responsible for your Medicare claims that you are no longer covered by an employer’s plan and that Medicare will now be the primary payer. Make sure they know the effective date of this change.
Last, but not least, inform your health care providers of your change in primary coverage so they can direct their claims to the proper insurer for payment.
HAPPENINGS:
Nov. 19: “Senior Safety During the Holidays” seminar, 1:30-3 p.m. at Westlake Village Civic Center, 31200 E. Oak Crest Drive in Westlake Village.
Dec. 17: “Will You Pass Your Next Driving Test” seminar, 1:30-3 p.m. at Simi Valley Senior Center, 3900 Avenida Simi in Simi Valley. For reservations call 583-6363.
MEDICARE ONE-STOP-SHOPS:
Nov. 19: 9 a.m. to 1 p.m. at Camarillo Health Care District, 3639 E. Las Posas Road in Camarillo.
Nov. 20: 8 a.m. to 3 p.m. at Area Agency on Aging Offices, 646 County Square Drive in Ventura.
Nov. 21: 9 a.m. to 3 p.m. at Goebel Adult Community Center, 1385 E. Janss Road in Thousand Oaks.
