Medicare and Cobra
Cobra is temporary insurance that allows people to remain on their group health plan after leaving employment for up to 18 months. It is the same health insurance as before except you pay 102% of the premium (including what the employer was contributing). This can be the best option coverage wise and even pricewise for some if under 65.
If you are 65 or older and you or your spouse is offered COBRA, YOU MUST GET Medicare to avoid any penalties. Medicare DOES NOT consider COBRA coverage as good or better than Medicare (“not creditable”). What’s worse if you do NOT enroll in Medicare not only will you be penalized but COBRA will not pay your bills because they are secondary.
When an insurance company is secondary that means that their contract and applicable laws dictate that they reduce their payment by the amount the first (primary) company would pay their share and that the second company pay only AFTER the first company. The Medicare Secondary Payer rules are complex. Much of the bill-shuffling takes place behind the scenes.
If you are 65 and over, you can apply for Medicare at ANY time (while covered by employer health insurance/group health insurance). You also have up to 8 months are to sign up for Medicare when your group coverage ends. The problem with signing up after coverage ends is that YOU WILL have a lapse in health insurance UNLESS you take Cobra.
Most HR personnel and the average person do not realize that COBRA is not as good as Medicare and that YOU should sign up for Medicare before you (or your spouse) leave your employer. Here is the bottom line: RETIREMENT AFTER 65 = SIGN UP for Medicare (whether you are taking COBRA, Medicare Supplement, Medicare Advantage, Tricare, VA, or your employer’s retirement plan).
Doctors & Medicare
The biggest concern most people have when switching to Medicare is how—and by whom—their health care services will be delivered. Will you still be able to see their same doctor? If you don’t currently have a primary care doctor, will you be able to get one under Medicare? What if you need a specialist? Will you have any say in choosing that specialist, and will the bills be covered under Medicare?
When you keep original Medicare as your primary insurance (and you may or may not choose to buy a Medicare supplement also known as a Medigap plan) - the federal government pays your doctors (they hire a contractor to do it on their behalf). A recent survey from KFF (Kaiser Family Foundation) showed that only 1% of providers nationwide do NOT accept Medicare patients. That does not include providers that accept Medicare but not accepting new patients with Medicare. Every three months Medicare sends out a summary notice to show you all claims presented and paid. Learn more here.
When you choose a Medicare Advantage plan, the private insurance companies pay your doctors, hospitals, etc. Providers have to be in the plan network and rules must be followed for your care to pay for. Nationwide 46% of providers participate in a Medicare Advantage network. Important questions to ask before selecting a Medicare Advantage plan are:
Learn more about Medicare Supplement plans here, learn more about Medicare Advantage plans here.
No matter which way you receive your Medicare benefits (even if you have retirement health insurance, Federal Insurance, Tricare, VA, and more) we can help you and answer all of your Medicare questions.
Heather Majka, Certified Social Security Claiming Strategist, Owner of Citizens Insurance Solutions
With over 25 years of industry experience, Heather is a subject matter expert. Heather has two adult children serving in the US military (Naval Aircrew and US Army). Heather's husband is a US Army SNIPER Veteran that served during Desert Storm. Heather has is a native New Yorker who has lived in Virginia, Texas, Florida, and now lives in Tennessee.