Medicare for Dummies
November 30, 2018 10:39 AM   Subscribe

Mr. BlahLaLa is turning 65 shortly. Where can we get unbiased factual information about what he needs to do about signing up for Medicare?

Mr. BlahLaLa is still working, and plans to be working for some time. He is in a union and has union healthcare. He's been bombarded with information -- from the union's plan, from every other Medicare part whatever provider via mountains of mail, etc -- but it's all super unclear and even contradictory.

What does a person do if he:
-- Is turning 65.
-- Is still employed and plans to be employed.
-- Has enough banked hours/vesting that when he does stop working, he can retire and still be covered via the union health insurance?
We know that he must sign up for Medicare. We know that Medicare becomes his primary insurance and the union plan his secondary. But how can we get the entire story about the various parts, what he must sign up for now, what he can wait for until later, etc.

posted by BlahLaLa to Health & Fitness (9 answers total) 7 users marked this as a favorite
I'm not sure Medicare becomes the primary and the union the secondary, seriously check into that. When I signed up a couple of years ago HR at work told me my work insurance would be my primary. Work insurance (state employee, not union) sucked so bad I got rid of it.

Someone in HR where he works should be able to help sort through this.
posted by mareli at 11:08 AM on November 30, 2018

Call the Medicare Rights Center.

(Probably Unnecessarily Full Disclosure: I used to work for an organization that was a partner with MRC on a number of grants and programs.)
posted by gauche at 11:36 AM on November 30, 2018

Try your local SHIP (State Health Insurance Plan) office. They can provide free Medicare counseling. In my state SHIP is called HICAP (Health Insurance Counseling and Assistance Plan), there are other names as well. You can find your state's contact info here.
posted by assenav at 11:38 AM on November 30, 2018 [1 favorite]

A shop steward or another rep from his union would be a good person to ask as well.

The coordination of benefits rule is that, while he's still actively employed, his group insurance from work is primary payor and Medicare is secondary, and once he retires, Medicare is primary and his vested retiree insurance is secondary.

It is almost always advantageous to enroll in Medicare Part A even if you have other coverage, but depending on the specifics of his plan it could make sense to defer Part B, especially while he's still working. This is very dependent on the exact details of his work coverage, though. The resources folks have mentioned here can help work through the details of that.
posted by strangely stunted trees at 11:44 AM on November 30, 2018 [1 favorite]

Funny you should ask - I'm in the middle of this with continuing coverage through my spouse. I went to and clicked a little box that said "Find someone to talk to", selected my state and called the number listed. It was to a clearinghouse where a very nice man asked me which county I lived in in my state (PA), and then gave me the phone number for an impartial nonprofit contracted with Medicare to give this kind of specific information.

One thing that I discovered in my search is that I need to sign up for part A (it's free). Part B can be postponed without penalty if your employer has 20 or more employees insured. I called HR to find out, and I'm exempt. Otherwise, if you don't sign up right away there is a penalty, and the price per month is higher forevermore, so you want to check this out. There are specific circumstances for the part B exemption, and a counselor could explain much more fully and accurately, since I'm a MeFite, not a Medicare expert.

Part D (drug coverage) is something I never even thought to ask about, so might call my counselor back. I have comprehensive coverage for the next couple of years, so not something I need to purchase just yet, but I don't want to be penalized, either.

I was told that the sign-up can happen from 3 months before a person turns 65 to 3 months after.
posted by citygirl at 11:45 AM on November 30, 2018 [5 favorites]

Please make sure you are adequately covered for prescriptions. My cancer support board is full of people scrambling to figure out how to pay for the $30,000/month for the rest of our lives medication that is the standard of care.
posted by FencingGal at 11:51 AM on November 30, 2018 [2 favorites]

The Medicare for Dummies book is actually pretty good.
posted by mono blanco at 11:55 AM on November 30, 2018 [1 favorite]

Having gone through the whole coordination of benefits issue recently on behalf of Mr. DrGail, who is a retired Federal employee, here's the scoop:

-As said upthread, his work insurance is primary while he is still working. Once he retires, Medicare becomes primary and the work insurance (or the continuation for retirees, in his case) is secondary
-If he takes Medicare B, which costs about $100/month, and the work insurance is a standard PPO (i.e., not a HD or consumer-driven plan), whichever insurance is secondary picks up pretty much whatever the primary insurance doesn't. Deductibles, copays, etc. are all taken care of, so the annual out-of-pocket is basically nil, except for prescription copays. This is great.
posted by DrGail at 2:57 PM on November 30, 2018

It is a confusing mess though there are answers out there. I just went through this process last Jan 2018 and it was a bit confusing especially when my wife's employer gave incorrect information. I am not an agent, or an expert by any means - you MUST research this for your particular circumstance.

As citygirl said, it is very important to note what your employer/union plan includes or not. Sure, ask your HR but also corroborate with CMS (Centers for Medicare & Medicaid Services) as well.

Per ACA (Obamacare) if you are currently employed with a company/employer with greater than 20 employees your employer/union health plan (may be) is primary though you need to sign up for Part A, though Part B and Part D may be deferred because, in a company with health benefits and greater than twenty employees, you are able to retain your "Special Enrollment Period" until you or your spouse whom you are covered through lose your/their job, retire or are terminated; alternately, if your company has fewer than twenty employees Medicare is primary and you need to sign up for Part A and Part B and Part D prescription plan.

I believe you have three months prior to your birthday, the month of your birthday turning 65, and three months post birthday to enroll before penalties set in - double check that. Check the official "Medicare and You" government publication - that is a MUST have booklet. Avoid the penalties. Part A is critical, sign up. Part B and Part D are also critical at the time you turn 65 unless you are certain you will continue to be covered by your employer/union health plan and will be able to document "Creditable Coverage" via that plan based on number of employees in the company rule to preserve your "Special Enrollment Period". Part A is primarily hospitalization while Part B is doctor's visits, outpatient hospital services, certain home health services, durable medical equipment, and other items (a must have especially if you are in poor health, with a chronic condition)... Part D coverage is prescription coverage. If you are not entitled to coverage through your employer/union plan per the twenty+/- employee rule and delay Part A or Part B and Part D, penalties kick in after the enrollment period on a penalty per month basis and can be costly, very costly.

But, you still need to refer to your employer/union benefit to see how Medicare is integrated or not. This also applies to a spouse covered by his/her spouse's insurance plan.

Again, the CMS "Medicare and You" publication is indispensable - get a copy if Centers for Medicare & Medicaid Services, CMS has not already sent you one.

Google the term "How does Medicare work with my current employer insurance?" and you'll get a number of hits explaining this. Clarify with CMS by appointment and or call additional resources listed in the "Medicare and You" booklet.

Next you need to consider a Medigap policy. Take a look at Medicare Supplement Plans F, G, and N. It's an additional monthly cost but is comprehensive paying most of what Part A and Part B does not cover. These policies are not offered by the government but are private plans offered by private insurance companies. But, as with Medicare, they also have a "Special Enrollment Period" where you cannot be denied because of prior conditions or poor health - the private companies ARE obligated to accept during that enrollment period. After the specific enrollment period though, when the enrollment period expires, the companies can screen the heck out of you for prior conditions.

Good luck...
posted by WinstonJulia at 4:45 AM on December 1, 2018

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