Medicare is a federal medical insurance program, which includes Original Medicare. Original Medicare is a low-cost government insurance program that guarantees access to health insurance for Americans age 65 and older and younger people with certain medical disabilities. It pays for many health care expenses, but not all.
How It Works
Medicare covers its share of an approved amount and you pay the rest through deductibles and coinsurance. Original Medicare is made up of two parts:
Part A is hospital insurance. It covers inpatient hospital care, skilled nursing facilities, hospice, lab tests, surgery, and home health care.
- Part B is medical insurance. It covers things like clinical research, ambulance services, durable medical equipment, mental health services, limited outpatient prescription drugs, and more.
You are automatically eligible for Medicare Parts A and B when you become Medicare-eligible. If you are receiving Social Security benefits, you may be enrolled in Medicare automatically.
If you have to sign up to get coverage, you can enroll starting three months before the month you turn age 65. The deadline to enroll is three months after the month you turn age 65. (Note: You can wait to enroll in Part B; however, you may have to pay a late enrollment penalty. However, in general, you can wait to enroll in Medicare Part B without facing a late enrollment penalty until your active employment ends or the date your coverage under your employer’s plan ends, whichever occurs first. Consult your Medicare advisor for more details.)
Part D is optional prescription drug coverage. You can enroll in Part D if you want coverage to help pay for your prescription drug costs.
How Medicare Works with Company Coverage
If you are actively employed, your company’s health plan will be your primary medical coverage, and, if you choose to enroll in Medicare, Medicare will be your secondary coverage. Please note, once you are enrolled in any part of Medicare (Parts A or B), you can no longer make contributions to an HSA, even if you are also covered by an HSA-eligible medical plan.
If you are retired and have coverage through your previous employer, Medicare will be your primary medical coverage, and your company’s health plan will be your secondary coverage.
As you prepare to transition to Medicare, you will want to understand if your dependents under age 65 will be eligible for coverage under your company’s health plan. To understand your options, contact the Equitable Benefits Center at 1.800.829.2633 from
9:00 a.m. to 5:00 p.m ET, Monday through Friday.
How Medicare Works With COBRA
If you are eligible for Medicare Parts A and B but you choose to not enroll in Medicare Parts A and B, you may face potentially significant out-of-pocket expenses. COBRA coverage pays secondary to Medicare Parts A and B. Therefore, the plan will pay as if Medicare has already made a payment, even if the Medicare-eligible individual did not actually enroll in Medicare.
If your Medicare benefits (Parts A or B) become effective on or before the day you elect COBRA coverage, you can have COBRA and Medicare coverage. This is true even if your Part A benefits begin before you elect COBRA coverage but you don’t sign up for Part B until later.
If you become entitled to Medicare after you’ve signed up for COBRA coverage, your COBRA coverage may be terminated by your plan as of the day you enroll in Medicare. (But if COBRA covers your spouse and/or dependent children, their coverage may continue.)
To Learn More
Start here (PDF) to better understand Medicare, your options, impacts to your current coverage, and more. Below are resources where you can find additional information and help:
- Visit the Social Security website or call 1.800.772.1213 (TTY 1.800.325.0778) between 8:00 a.m. and 7:00 p.m. Monday through Friday
- Review the Medicare & You handbook from the Centers for Medicare & Medicaid Services