By Betty Berry, Tuesday, Nov. 8, 2011
QUESTION: I retired before age 65 and have health care benefits from my employer. Will this coverage be considered a Medicare supplement when I go on Medicare?
ANSWER: Since you are not yet age 65, your employer-provided health care benefit remains your primary coverage. When you reach age 65 and are covered by Medicare, those benefits, if continued, will become secondary coverage and that coverage may change.
Employer plans may or may not provide the same benefits as the Medicare Medigap plans.
Employer plans are known as carved-out policies that may provide less coverage, equal coverage or better coverage than the government-regulated policies known as Medigap policies offered by numerous insurance companies.
The coverage depends on the contract between your employer and the insurance company. Coverage also will vary depending upon whether the employer’s plan is a fee-for-service plan or a managed-care plan such as an HMO or PPO.
It is most important that you understand exactly what you can expect from the employer’s coverage and compare that coverage to the Medigap plans.
Many times, an employer’s plan is equal to or better. Before deciding to drop that coverage, consider all other options, as once an employer’s plan is dropped, it usually cannot be reinstated.
To determine the adequacy of the coverage, ask the following questions: What will the plan pay after Medicare has paid? Does the plan pay for services Medicare does not cover? Will the plan cover you if you move out of the area? Is the plan guaranteed renewable? Are there annual or lifetime limits on benefits? Do you have a choice of plans? Does the plan cover prescription drugs? What is the cost of the plan to you?
If your spouse is under 65 and covered by your retirement plan, you need to determine whether that coverage continues after you reach 65 and your coverage becomes secondary.
Read your benefits booklet or health care policy carefully because these types of plans are changing rapidly.
For all unresolved questions, contact your employer’s human resources department for assistance in determining the coverage provided.
HAPPENINGS
Just a reminder: The annual open enrollment for Medicare enrollees to make changes to health care coverage for 2012 continues through Dec. 7. If you want to change your health care coverage or prescription drug coverage, this is the period to do so. The plans you are enrolled in on Dec. 7 will be your coverage for 2012.
One-Stop Shop: Provides assistance with selecting Medicare Part D prescription drug coverage for 2012. One-Stop Shops are planned today at the Simi Valley Senior Center, 3900 Avenida Simi from 1 to 4 p.m., and Friday and Nov. 21 at the Goebel Senior Adult Center, 1385 E. Janss Road, Thousand Oaks, from 10 a.m. to 3 p.m. For information and additional locations, call 800-434-0222.
Today: Seminar from 1:30 to 3 p.m., “Will You Pass Your Next Driving Test?” at the Westlake Village Civic Center, 31200 E. Oak Crest Drive.
Nov. 13-19: Senior Citizens Week Book Festival at Bank of Books, 748 E. Main St., Ventura. There will be speakers, a salute to veterans and tributes to senior citizens. Call John at 643-3154 for more information.
