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Pareja de ancianos

I have Medicare and  I am age 65 or older and am covered by the group health plan based on my own employment status or my spouse's employment status.

  • If the employer has 20 or more employees, then the group health plan pays first and Medicare pays second.  

If the group health plan didn't pay your bill in full, the doctor or health care provider must bill Medicare for secondary payment. You may have to pay costs that Medicare or the group health plan doesn't cover.

Employers with 20 or more employees must offer current employees age 65 and older the same health benefits, under the same conditions, as those offered to employees under age 65. If the employer offers spousal coverage, it must offer the same coverage to spouses age 65 and older that it offers to spouses under age 65.

  • If the employer has fewer than 20 employees and is not part of a multiemployer or multiemployer group health plan, then Medicare pays first and the group health plan pays second. The employee must enroll in Medicare, Part A and Part B, and a Medicare Advantage or Medigap plan plus Part D drug plan, if it costs less than the company's plan.

If the employer has fewer than 20 employees, the group health plan pays first and Medicare pays second if the following conditions apply: The employer is part of a multiemployer or multiemployer group health plan at least one of the other employers has 20 or more employees

Check with your Human Resources department about your plan and ask if it will pay first or second, find out the detailed conditions of the plan's benefits and compare them with the benefits and costs you would have if you took Medicare and a Medigap plan or a Medicare Advantage plan.

 

When you are working for a company that has more than 20 employees, the company's group plan is primary and Medicare is secondary. Since Medicare is secondary, you can delay the registration in Part B without penalty. You can also delay signing up for Part D without penalty if your employer's drug plan is creditable, meaning it's equal to or better than Medicare Part D.

You could also delay filing Part A, but it doesn't make sense since this part was already paid for by your annual contributions at tax time for more than 10 years.

If you are contributing to an HSA (Health Savings Account) and plan to continue doing so, do not sign up for Part A or any part of Medicare. The IRS does not allow these contributions when you sign up for any part of Medicare.
 

Sometimes people continue with their company's group plan because they have their spouse and children under the plan's benefits and this requires that the employee be enrolled in the company's plan. Do a cost analysis of your alternatives.  

If the person has Medicare Part A, loses his job and enrolls in COBRA, this does not exempt him from having to enroll in Medicare Part B within 8 months of the loss of employment.

I am a veteran and have veterans benefits.

If you have (or may have) both Medicare and veterans benefits, you can receive treatment under either program. Generally, Medicare and the  US Department of Veterans Affairs (VA)  they cannot pay for the same services or items. Medicare pays for Medicare-covered services or items. VA pays for services or items authorized by VA. Every time you receive health care services or visit the doctor, you must decide which benefits you will use.

In order for VA to pay for services, you must go to a VA facility or have VA authorize services at a non-VA facility.

If VA authorizes services at a non-VA hospital, but did not authorize all of the services received during your hospital stay, then Medicare may pay for Medicare-covered services that VA did not authorize.

I am covered by TRICARE.

If you're an active duty military and enrolled in Medicare, TRICARE pays for Medicare-covered services and items first, and Medicare pays second. If you are not on active duty, Medicare pays first for Medicare-covered services and TRICARE may pay second.

If you get items or services from a military hospital or other federal health care provider, TRICARE pays first.

More information about  TRICARE .

Individual coverage through the Affordable Care Act (ACA)

When you reach age 65, you lose the government subsidy for the ACA, you have the obligation to take Medicare when you are eligible for having worked and paid taxes for 5 years or more. If you are not eligible, you can remain covered by the ACA.

For any additional information see  www.medicare.gov.

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