QUESTION: 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?
ANSWER: Medicare needs to know about other health care coverage in order to establish your benefits file and to determine whether or not Medicare will be your primary coverage.
Usually when a person becomes eligible for Medicare, 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 shifting 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 years of age or older and continue to work or you are 65 or older and have a spouse, of any age, 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 very 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:
TUESDAY – November 17 – 5:30 to 7:30 pm – The Empowered Caregiver Series – Seminar – “Family Dynamics” at Senior Concerns Day Care Center, 401 Hodencamp Road in Thousand Oaks. For reservations call (805) 497-0189.
WEDNESDAY – November 18 – 1:30 pm – Seminar – “Scammers Enjoy the Holidays Too” at Westlake Village Civic Center, 31200 E. Oak Crest Drive in Westlake Village. For information call the Advocate’s office (805) 495-6250.
MEDICARE ONE-STOP-SHOPS – assistance and counseling with making changes in your healthcare coverage for 2016 – walk-ins are welcome.
THURSDAY – November 12 – 9:00 am to Noon at Wilson Senior Center, 350 North C Street in Oxnard
THURSDAY – November 12 – 10:00 am to Noon at Palm Vista, 801 South C Street in Oxnard
FRIDAY – November 13 and MONDAY November 16 – 9:00 am to 3:00 pm at the Area Agency on Aging offices – 646 County Square Drive in Ventura
MONDAY – November 16 – 10:00 am to Noon at Port Hueneme Senior Center, 550 Park Avenue in Port Hueneme
TUESDAY – November 17 – 11:00 am to 3:00 pm at the Area Agency on Aging offices, 646 County Square Drive in Ventura
WEDNESDAY – November 18 – 10:00 am to 1:00 pm at Moorpark Active Adult Center, 799 Moorpark Avenue in Moorpark
