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Straight Talk Recap: Medicare

Straight Talk Recap: Medicare

| August 24, 2017

We constantly receive emails from, who we like to refer to, as “Joe” or “Sandy”, commonly on the show. Also known as concerned individuals seeking help during a transition that can often seem overwhelming: Medicare and retirement. This week, I wanted to share some valuable advice on a question I often receive:


"I have listened to you and your dad on the radio many times. Question: My husband turned 65 in May. He is still working and will need to continue working for several more years. He has insurance for both of us from his employer. Does he need to apply for Medicare or wait till he actually retires? We have gotten conflicting information from friends and a financial person he contacted. I would like to know once and for all if it is required that he apply at this time. Thank you. "

So what is the once and for all answer? It’s no.

Sandy’s husband will not need to apply for Medicare at this time, in fact I would advise against it.  For this reason – Medicare only requires enrollment if you do not have group health insurance coverage when you turn 65.  Her husband is currently covered by an employer plan (group health insurance), therefore he does not need to enroll in Medicare.

The reason I advise against enrollment at this time? It’s that Medicare will always be secondary to his current coverage – this means, the employer coverage pays first, then Medicare will pay.  They will not pay the full balance of the remainder of the bill, only up to 80% of the claim.  This generally translates to: Medicare rarely pays after an employer based plan does, so if he were to enroll in Medicare he’d be paying a premium for coverage that he very rarely, if ever, would see a benefit from.

When Sandy’s husband decides to retire and leaves his employer based coverage – he can then enroll in Medicare without any medical underwriting (meaning he will be automatically enrolled, no health questions) and free of any penalties.  This is called a special election, and it will be available to him because he will be leaving employer based coverage.

Never hesitate to reach out!

Health Insurance Coach & Vice President

The opinions voiced in this material are for general information only and are not intended to provide specific advice or recommendations for any individual.