Dear Marci
Dear Marci,
I’m trying to understand how my retiree insurance will work with Medicare. What kind of coverage can I expect if I have Medicare with retiree insurance?
– Yan (Dover, OH)
Dear Yan,
When you have both retiree insurance and Medicare, your coverage will depend on the type of retiree insurance plan you have. Below are a few common types of retiree plans and how they might work with Medicare:
- Fee-for-service (FFS) plans: These plans pay for care from any doctor or hospital. They cover Medicare cost-sharing and work like supplemental insurance.
- Managed care (HMO or PPO) plans: These plans require you to see in-network providers and facilities. Your costs are typically lowest when you see providers who take both Medicare and your retiree insurance. If you see Medicare providers who don’t take your retiree insurance, you will pay regular Medicare cost-sharing amounts, and your retiree insurance might not pay at all.
- Employer-sponsored Medicare Advantage Plans: These plans offer both Medicare and retiree health benefits. Some employers require that you join their Medicare Advantage Plan to continue getting retiree health benefits after becoming Medicare-eligible. You can choose not to take your employer’s coverage and sign up for Original Medicare or a different Medicare Advantage Plan. Keep in mind, though, that you might not be able to get your retiree benefits back later.
- Employer-sponsored Medigap policies: These plans offer supplemental insurance for Medicare-eligible individuals. You need to have Original Medicare to enroll in a Medigap plan. Remember, you can always choose not to take your employer’s coverage and sign up for a Medicare Advantage Plan or a different Medigap. You might not be able to get your retiree coverage back later, though.
Retiree insurance is almost always secondary to Medicare. This means it pays after Medicare. Retiree insurance might provide coverage for Medicare cost-sharing, like deductibles, copayments, and coinsurance. It might also pay for care or other items and services that Medicare doesn’t cover. Examples include vision care, dental care, and off-formulary or over-the-counter prescription drugs.
For more information on your retiree insurance plan, contact your benefits administrator or your employer’s human resources department.
Hope this answers your question!
-Marci