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Why should mom apply for Medicare?

She is still working and has full coverage through her employer and she pays nothing out of pocket right now.
Status: Open    Feb 22, 2015 - 10:41 AM

Medicare/Medicaid

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Expert Answers

Jul 09, 2015 - 07:32 AM

If mom is working and is eligible for Medicare, she should contact her employer's HR department and verify with them that her medical plan is "creditable."

Her health plan would need to have a prescription plan that satisfies the following per cms:

1) Provides coverage for brand and generic prescriptions;

2) Provides reasonable access to retail providers;

3) The plan is designed to pay on average at least 60% of participants’ prescription drug

expenses; and

4) Satisfies at least one of the following:

a) The prescription drug coverage has no annual benefit maximum benefit or a maximum annual benefit payable by the plan of at least $25,000, or

b) The prescription drug coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 annually per Medicare eligible individual, or

c) For entities that have integrated health coverage, the integrated health plan has no more than a$250 deductible per year, has no annual benefit maximum or a maximum annual benefit payable by the plan of at least $25,000 and has no less than a $1,000,000 lifetime combined benefit maximum.

As long as the above criteria is met, she can apply for Medicare benefits upon her leaving her job or losing coverage through her employer without incurring any penalties for no applying for coverage at the time she is eligible. If it is not the case, she will limit when she can apply for coverage and will incur a lifetime penalty for the time she had no creditable coverage.

Aug 24, 2016 - 09:02 AM

If her employer is 19 or fewer employees she should sign up for Part A and B Medicare as Medicare is Primary coverage at that point. If 20 or more employees then the Group health plan is primary and Medicare is not required. But Part A is free for most citizens so most people activate Part A when eligible.

Aug 24, 2016 - 09:16 AM

Anyone covered by an employer sponsored plan is considered to have credible coverage, and is not required to take Medicare Part B. Your mother may elect to drop her employer sponsored health coverage and take Medicare Part B if that fits her needs better. It is up to each person in that situation to evaluate whether the employer provided health coverage or Medicare is best for them.
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