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Coordination of Medicare And Other Health Benefits

Medicare And Group Health Insurance

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It is becoming more and more common for people who qualify for Medicare because of their age to also have a group health insurance policy. More and more people are working past age 65 -- especially now that Social Security removed the earnings penalty from the retirement benefits for people who work after age 65.

Because of age discrimination laws, employers are prohibited from offering any unique type of insurance to employees over age 65, such as a special Medicare Supplement plan. They must offer employees over 65 the same package of benefits that they offer younger employees. So, if a Medicare beneficiary continues working, the choice is either a broad health insurance plan or to decline all coverage.

It is worthwhile for people with Original Medicare to have additional insurance to cover the gaps Medicare doesn't pay.  Health insurance through work is one of the ways to fill those gaps.

Medicare only applies Coordination of Benefits rules when the second policy is a group health policy from an employer or a union. (Medicare refers to the situation as "Medicare Secondary Payer" (MSP) Program) It does not apply Coordination of Benefits rules if you have both Medicare and an individual health insurance policy, or Medicare and a group policy other from an employer or union. In these cases, Medicare ignores the individual plans.

"Coordination of benefits" rules will be applied even if one of your group policies doesn't include a provision about the subject.

The coordination of benefit rules are different in each of the following situations:

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