• Ferguson Insurance Services

I'll be 65 soon and I'm covered under my or my significant other's employer plan. Do I add Medicare?

Not everyone is ready - or willing - to retire when they turn 65.


If that is you, and you want or need to continue working, then you have a few decisions to make, because if you are still working and receive your health and prescription drug benefits from your employer, then you may want to delay enrollment.





First, let's get this out of the way: if you qualify for premium-free Medicare Part A, at least enroll in that in the three-month window before your 65th birthday. If anything, it can give you some additional inpatient coverage and you won't pay anything additional for it. Employees who participate in or fund and Health Savings Account may want to delay, but that is something you may want to speak to your accountant about.


OK-so here are some scenarios that might apply to you:


1) You (or your spouse whose plan covers you as a dependent) are employed by a

company with 20 or more employees.

Medicare pays after your employer plans pays. Medicare doesn't always pay the

balance in full after an employer plan pays, so it may not benefit you to enroll in

Part B if you keep your employer plan, given that you may also have to pay a

premium for Part B, which at a minimum will cost approximately $145 a month

(in 2020).


2) You (or your spouse/domestic partner whose plan covers you as a dependent) are

employed by an employer with 20 or fewer employees.

Medicare pays before your employer plan.

-I'm going to pause here because this next part is important.-

I'm writing this from my desk in Washington. In my state, with most

employer plans I see provided by employers domiciled (or

headquartered or based) in Washington, in most cases, it is OK to

delay enrollment in Medicare Part B. Most-not all.


I highly recommend that you contact your insurance carrier and have

them confirm the Medicare coordination section of the contract.

Don't expect them to have the answer right away. Instead, expect that

they may have to set you on hold to find that section. Health plan

contracts are not short.


You can also contact your HR department, but usually I recommend

that you contact the Customer Service department at the carrier.

Write down who you spoke to, the date and time as well. Just in case...

Heck, ask for a copy of the plan contract. And remember that plan

contracts and language can change annually, even if your cost-sharing

doesn't change.


Now, most states are not like Washington. Just two hours down the

interstate in Oregon, most employer plans down there are different.

In Oregon, plan on enrolling in Medicare Parts A and B if your

employer is a small company.

My point is, do your research and call your carrier and double check.


Whew, that's out of the way.


As always, if you have additional questions, please call Ferguson Insurance Services, LLC., at (360) 400-0530, or send me an email at jennifer.f@fergusoninsservices.com. I'm always happy to answer your questions or schedule a time for a longer chat.


Next week, I'll address what you should do if you are going to receive Medicare due to a disability and might be receiving employer coverage.


And did you notices that I haven't said anything about Part D Prescription Drug coverage? That's because it's a whole different situation. I think I'll tackle that one in two weeks.


#MedicarePartBwhopaysfirst #MedicarePartAB


Want some more reading material because you just can't get enough of this, or you don't want to call or wait for the next installment, check out the following publication from Medicare? It has a some additional information about other scenarios that I'll cover later. https://www.medicare.gov/Pubs/pdf/02179-medicare-coordination-benefits-payer.pdf

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