Medicare recipients who are still working have legal rights to employer-provided group health insurance.
Individuals may become eligible for Medicare when they become 65, receive Social Security disability benefits or require dialysis or a kidney transplant. If they also have group health insurance through their job or their spouse's employment, Medicare eligibility may affect their group health benefits.
The General Rule
Regulations contained in the Social Security Act require most employers to provide the same group health insurance benefits to employees or their spouses with Medicare as they do to all other employees The group plan will be primarily responsible for payment of medical care. Medicare can help pay deductibles and co-pays or for services covered by Medicare but not the group plan.
Small Employer Exception
The requirement to provide Medicare-eligible employees the same group health coverage as all employees does not apply to employers with fewer than 20 employees. The employer must have had fewer than 20 employees during at least 20 weeks of the current or previous calendar year.
Disabled Medicare Recipients
Recipients who have Medicare because they receive Social Security disability insurance benefits are entitled to continued group health insurance only if the employer has a large group health insurance plan---one that covers at least 100 employees.
Chronic Renal Disease
Regardless of the size of the group health plan, beneficiaries receiving Medicare due to end-stage renal disease have the right to continued group health insurance coverage for the first 30 months of Medicare eligibility. After 30 months Medicare becomes the primary payer.
Tags: group health, group health insurance, health insurance, Social Security, continued group, continued group health
