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Blue @ Work

How Medicare and employer insurance work together

Questions your employees don't know to ask.

Retirement is bound to be a part of every employee’s work cycle. You may even be able to identify a few employees within your workplace who are soon to retire.

Here’s the deal: If your employees would rather get a colonoscopy or shop for cable and internet plans than discuss Medicare or retirement, there’s a problem.

Can you blame them, though?

More than 70 percent of future (and current) retirees wish they had a better understanding of Medicare External Site. It’s difficult when your employees are unsure of the right questions to ask, where to start, what the future could look like, or even which health insurance carrier to go with. And, to top it all off, your employees have to keep in mind Medicare has penalties if they don’t sign up in time.

As your company’s HR or benefits administrator, you have a lot on your plate already and knowing the ins and outs of Medicare may not be at the top of your to-do list. But, that doesn’t mean it can’t be. At Wellmark Blue Cross and Blue Shield, we want you to be your employees ‘health plan hero’ even when it comes to navigating the complexities of Medicare.

Medicare not your area of expertise? We’ve done the hard work for you.

Achieve ‘health plan hero’ status — and still have time in your day for other tasks — when you review this comprehensive list of questions your employees (and maybe even you!) didn’t know to ask about Medicare.

How does Medicare work with an employer-sponsored health insurance plan?

First things first, there is no notification or warning from Medicare or Social Security Administration that prompts enrollment into Medicare — it's completely on the individual. However, having an employer-sponsored health insurance plan allows an individual to delay Medicare Part B without a penalty External Site even if they choose to keep working past 65. Please note: COBRA and retiree coverage does not qualify an employee to waive Part B.

What if my employee is on their spouse's insurance plan, will Medicare pay first?

Take it from the experts at External Site

Medicare pays first if both of these situations apply:

  • A domestic partner is entitled to Medicare on the basis of age.
  • A domestic partner has group health plan coverage based on the current employment status of his/her partner.

Medicare generally pays second when:

  • The employee's domestic partner is entitled to Medicare on the basis of disability and is covered by a large group health plan.
  • For the 30-month coordination period when the employee's domestic partner is eligible for Medicare on the basis of end-stage renal disease (ESRD) and is covered by a group health plan on any basis.
  • When the employee's domestic partner is entitled to Medicare on the basis of age and has group health plan coverage on the basis of his/her own current employment status.

What is the difference between Medicare supplement and Medicare Advantage?

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Medicare Supplement vs. Medicare Advantage

Medicare supplement: Also referred to as Medigap. This policy helps pay for some of the health care costs that Original Medicare doesn't cover (e.g. copays, coinsurance, deductibles).

A few things to keep in mind when it comes to choosing a Medicare Supplement plan:

  • A Medicare supplement policy is different than a Medicare Advantage plan.
  • Your employee pays the private insurance company a monthly premium for their policy in addition to the monthly Part B premium paid out to Medicare.
  • Medicare supplement plans only cover one person. If your employee has a spouse, they will have to get a separate policy.
  • Your employees can only purchase a Medicare Supplement plan from an insurance carrier licensed in your state to sell.
  • Medicare Advantage: Medicare Advantage plans are similar to purchasing a private health insurance plan. With these plans, office visits, lab work, surgery and more is covered with a small copay. However this could depend on HMO or PPO network plans and a yearly limit on out-of-pocket expenses.
    • Take note: similar to a private health insurance plan, there are varying rules and benefits. For example, one may come with prescription drug coverage, and another may require a referral to a specialist before you get a prescription.

    What can my employees do with their health savings account (HSA) when they switch to Medicare?

    When an employee enrolls in Medicare Part A, they are no longer eligible to contribute External Site pre-tax dollars to an HSA. The month an employee’s Medicare plan begins, they should switch their HSA to $0 per month. However, your employees can continue to withdraw money from an HSA after they enroll in Medicare to help pay for medical expenses (e.g., deductibles, premiums, copays and coinsurance).

    Should my employee keep our employer-sponsored health insurance or switch to Medicare?

    In most cases, your employee should only delay their enrollment to Medicare Part B if the employer-sponsored health plan is the primary payer (meaning it pays first for medical bills) and Medicare is second. Additionally, if your employees have a health savings account, they will no longer be able to contribute when they enroll in Medicare, however it can be a case-by-case scenario. Search for form numbers: N-2319173 (IA) or N-3319285 AN-T (SD) on the Wellmark Marketing Toolkit External Site to download and work through the “Medicare Costs: Let’s Do the Math” worksheet with your employees to determine the best option for them.

    • Medicare Part A (hospital coverage):

      In general, Medicare Part A covers: External Site inpatient care in a hospital, skilled nursing facility care, and inpatient care in a skilled nursing facility (not custodial or long-term care), hospice care, and home health care.
    • Medicare Part B (medical coverage):

      Medicare Part B covers two types External Site of services:
      • Medically necessary services: Services or supplies that are needed to diagnose or treat your employee’s medical condition.
      • Preventive services: Health care to prevent illness (e.g., flu) or detect it at an early stage.

    What are the different penalties for Medicare Part A and Part B?

    • Medicare Part A penalty:

      Typically, Part A is completely free External Site to those who are eligible. But, if an employee isn’t eligible for premium-free External Site Part A, and doesn’t sign up for it when they are first eligible, their monthly premium may increase.
    • Medicare Part B penalty:

      If an employee doesn’t sign up for Part B when they are first eligible, they will pay a late enrollment fee External Site and will continue to pay this fee for as long as they continue with Part B. Note: If an employee remains on the active employer plan, then they will not incur Part B penalties by delaying enrollment.

    It’s true, Wellmark Blue Cross and Blue Shield members get more.

    With Wellmark, your employees will get more than a Medicare supplement plan, they’ll get peace of mind knowing their coverage is coming from a company they know and trust. Your employees can also count on a variety of extra programs and services such as:

    • Exclusive discounts through Blue365®.

      Your employees receive Blue365 discounts External Site on gym memberships, heart rate monitors and more.
    • Prescription drug coverage.

      Employees have the option to enroll in a prescription drug plan to help pay for drug costs.
    • BlueSM

      Find member stories, recipes, health tips and more. The magazine comes in the mail, but exclusive content Opens in a new window can be found online at any time.

    Questions? Contact your authorized Wellmark account representative, or email us at