Medicare Coordination of Benefits

Don’t get caught up in a coordination of benefits mess when you enroll in Medicare. Some people have Medicare as well as employer health insurance.  This has caused confusion for a few of my clients.

If a person has two major medical policies, one policy must be designated as primary and one must be secondary. I heard from a client who just started his Medicare on March 1st but did not cancel his employer coverage, so neither coverage was designated as primary or secondary. Now he’s finding that neither policy wants to pay his $300 doctor bill.

I am very surprised that Medicare would know that my client has other health insurance. But they did know it and it put my client in the middle of a coordination of benefits mess.

I have just emailed another client who turns 65 in May but thinks he can’t drop his employer coverage until July. I have told him to definitely talk to his HR department because his employer will be more than happy to get him off their insurance policy. His employer is large enough that he could have delayed his Medicare enrollment and stuck with his employer coverage – but the employer plan is not as good as Medicare plus a Medicare supplement.

If a person works for a small employer (with fewer than 20 employees), he must enroll in Medicare when he turns 65.

If a person works for a large employer (with good health insurance), he does not need to enroll in Medicare.

I don’t know why people think they need to have Medicare AND an employer plan. But some people have gotten bad advice and ended up paying for two major medical policies when they only need one.


I have written about rules that govern who must enroll in Medicare – and how they can be penalized if they make a mistake about their health insurance coverage.


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