Medicare + Spouse's group Coverage?

[GNCamry99]

Medicare + Spouse's group Coverage?
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Thanks for replies to my threads. I have medicare part A and B.


I am having Medicare coverage and debating to evaluate about having dependent coverage via my spouse's group plan coverage from employer.


Medicare says :

Your spouse’s plan pays first, and Medicare pays second

What are the advantage and disadvantage of maintaining two plans and paying two premium?


Shall I suspend my Medicare and get coverage 100% from as dependent coverage via my spouse's group plan coverage from employer?


Will I able to reclaim my medicare, when I loose coverage from my spouse's group plan coverage from employer?





Thanks for your guidance.

[Lillie767]

Is your spouse an active employee or retired?

[Parnassia]

Originally Posted by GNCamry99

Medicare + Spouse's group Coverage?
==================================================
I am having Medicare coverage and debating to evaluate about having dependent coverage via my spouse's group plan coverage from employer.

Medicare says :

What are the advantage and disadvantage of maintaining two plans and paying two premium?

Well, the obvious disadvantage would be paying two premiums. Without knowing anything about what your spouse's plan covers, at what percentages or copays, no way to know whether retaining your Medicare would be an advantage or not. The coverages might overlap enough to the point they're redundant. If the employer coverage pays for services or prescriptions Medicare doesn't, it could function like a Medigap. YOU'LL need to dig in and read the fine print on what both types of coverage will and won't pay to figure out whether it makes financial sense or not. Do a side-by-side comparison. One example might be if you take an expensive or lots of prescriptions Medicare doesn't pay for. The employer plan might, but you'd need to figure in whether that additional premium offsets the benefit. Up to you to find out.

[GNCamry99]

Originally Posted by Lillie767

Is your spouse an active employee or retired?

Thanks for weighing in.



My spouse is an active employee and eligible for Medicare in few years.

[WRM20]

Will your spouses insurance actually cover you, or will it only act as Medicare supplement? Most plans will not let you suspend Medicare in favor of the employer benefit.

[Lillie767]

Here is some information.


https://www.cms.gov/Outreach-and-Edu...-retirment.pdf

https://www.uhc.com/news-articles/me...-employer-plan

[GWoodle]

There should be no premium for Part A. There is a standard premium for Part B.

What I can't answer is what the spouse group coverage costs & pays for you. Also don't know what prescription coverage you have. What you may have is no premium penalty for your Part A or B coverage. You need to check on your Part D coverage.

It appears in your case you need to go to HR & see what they say.

The obvious disadvantage is if you pay premium for something & not have any coverage. Another problem may be if the coverage does not amount to one of the Plans. Don't know the status of your health to have a clue for what coverage you need.

[southernlady5464]

Personal experience talking here. I had Medicare for over 9 years as secondary to my husband’s employer based coverage.

As long as claims were sent to his employer health plan first and then to my Medicare second, all was covered fine. Typically at 100%. Occasionally the dipwads would screw up and send to Medicare first and I’d have to get on the phone and remind them that IF THEY WANTED TO GET PAID, they had to submit to his employer plan first. Their excuse was that they were use to Medicare being primary. Even when I’d stand there and give them the cards in proper order telling them which one was primary and which was secondary. The dipwads usually wouldn’t listen which cost them time, money, and frustration. Not my issue.

That was my only issue with having both. Even if a procedure wasn’t covered by his insurance, and it was by Medicare, it would have to go to his first. But once it went thru his, Medicare picked up the tab.

I didn’t have to worry about Part D until we went to just Medicare.

[dkf747]

You won’t be able to suspend part A, so there’s no way to completely go on the spouse’s insurance. It will be as Medicare states - Medicare becomes secondary. You could suspend part B, but the spouse’s insurance might not cover you without both part A and B. I went through this a couple of years ago. We just pay two separate premiums because of it. The spouse’s coverage through her job is pretty cheap so it works.

[Lillie767]

One more educational fact sheet from CMS:

https://www.cms.gov/Outreach-and-Edu...rt-A-and-B.pdf