Employee Health Benefits at Work with Medicare - dummies

Employee Health Benefits at Work with Medicare

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Provided that your other insurance is primary to Medicare, by law the employer is subject to the following restrictions:

  • It must offer the same health insurance benefits to employees who are 65 or older as it does to younger employees.

  • It must offer covered spouses of any age (including 65 or older) the same health benefits as those offered to other employees’ spouses.

  • It must offer the same health benefits to employees or their spouses who have Medicare based on disability as it does to other employees.

  • It can’t require employees to drop employer benefits and enroll in Medicare.

  • It can’t offer employees who are eligible for Medicare any inducements designed to persuade them to choose Medicare and drop the employer insurance — for example, offering to pay their premiums or out-of-pocket costs for Medigap supplemental insurance or Medicare Advantage plans.

These rules are very important protections. In case you need to argue the point, the laws that established them are the Age Discrimination in Employment Act (ADEA) of 1967; the Tax Equity and Fiscal Responsibility Act (TEFRA) of 1983; the Deficit Reduction Act (DEFRA) of 1985; the Omnibus Budget Reconciliation Act (OBRA) of 1986; the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1986; and Medicare Secondary Payer rules.

If you think your employer is violating any of these rules, you can call the Equal Employment Opportunities Commission at 800-669-4000 to file a complaint. For more info, go to the EEOC website.

The laws mentioned earlier don’t give the same protections to people working for employers who have fewer than a certain number of employees (20 in the case of regulations affecting people 65 and older; 100 where younger people have Medicare because of disability).

This difference doesn’t mean that smaller employers can’t provide the same or similar protections, only that they don’t have to. It really depends on the individual employer, and you need to contact yours for details of its policy.