Retiree insurance is almost always secondary to Medicare, meaning it pays after Medicare and may provide coverage for Medicare cost-sharing like deductibles, copays, and coinsurance. Deciding whether to keep retiree coverage after you enroll in Medicare is a personal matter that depends on your anticipated health care needs and costs. Premiums for retiree coverage can be expensive, but it may be worth keeping your plan if you anticipate high Medicare costs. Retiree coverage may also pay for care or other items and services that Medicare doesn’t cover, such as vision care, dental care, and/or non-formulary or over-the-counter prescription drugs.
For more information about the services covered by your retiree insurance plan, contact your benefits administrator or your employer’s human resources department.
Retiree insurance may be coordinated with Medicare differently depending on the type of plan you have. Here are some common types of plans and how you can expect them to work with Medicare. Be sure to talk to your employer’s human resources department for more information.
- Fee-for- service (FFS) plans pay for care from any doctor or hospital. FFS plans cover Medicare cost sharing and generally act as a supplemental insurance policy.
- Managed care plans (HMO or PPO) require you to see in-network providers and facilities. Your costs are generally lower when you use providers that accept both Medicare and your retiree insurance. When you see Medicare providers that don’t accept your retiree insurance, you’ll pay regular Medicare cost-sharing amounts and your retiree insurance may pay nothing.
- Employer-sponsored Medicare Advantage plans offer people eligible for Medicare both Medicare and retiree health benefits. Some employers require you to join a Medicare Advantage Plan to continue receiving retiree health benefits after you become eligible for Medicare. You can always opt out of your employer coverage and join Original Medicare or a different Medicare Advantage Plan, but keep in mind that you may not be able to get that retiree coverage back if you want it at a later date.
- Employer-sponsored Medigap policies offer supplemental insurance for people eligible for Medicare. You must have Original Medicare to join Medigap. Remember: You can always opt out of your employer coverage and join a different Medicare Advantage Plan or Medigap, but you may not be able to get that retiree coverage back if you want it at a later date.
© 2022 Medicare Rights Center. Used with permission.
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