Health

One of the clearest signs that you might need glasses is the inability to read an actual sign. But there are many other clues that can reveal if your powers of observation are fading. The key to understanding the clues is fortunately not a mystery. It simply takes understanding the symptoms. Check out the following ten signs that may signal it’s time to schedule an eye exam.

1. Blurred Vision: If you no longer recognize a friend 10 steps away, or your favorite magazine has become too fuzzy to read up close, you may be developing farsightedness or nearsightedness. If you find it difficult to see objects both near and far, that may be astigmatism, a common condition involving a curvature of the eye lens or cornea.³
2. Difficulty seeing at night: If your night vision is fading so you no longer can see your dog in the yard or driving is becoming more of a concern, you may be experiencing signs of early cataracts, which should be examined as soon as possible.⁴
3. Trouble adjusting from dark to light: If it takes your eyes longer to adjust after seeing bright lights on the highway, it could mean the muscles that help your iris contract and expand are weakening. It’s likely due to age, as are many vision problems.⁵
4. Difficulty at the computer: You can try to blame it on work, but oftentimes those who struggle to read the computer after a while may be experiencing a clue to farsightedness. 
5. Eye strain or fatigue: Does 20 minutes of reading wear your eyes out like 1 hour did only a year ago? Eye fatigue results from blurry vision or when you regularly squint or blink to bring items into focus, but it also can occur from driving, writing or mobile phone addiction.
6. Frequent headaches: Sometimes the mechanism that helps the cornea and lens focus on images fails, and the small muscles in the eye are forced to work harder. The result is eye strain, which can lead to headaches.⁶ Put in simple terms: When you squint, it can cause headaches, and you may need glasses.
7. Double vision: Drinking jokes aside, double vision can lead to serious issues. Seeing double may indicate problems with your cornea or eye muscles. It can also be a symptom of cataracts. Call the eye doctor on the double.⁷
8. Wavy vision: Do the blinds covering the kitchen window suddenly look like they are under water? When straight lines appear distorted, or colors look faded, it may be a sign of macular degeneration, the deterioration of the central portion of the retina and a leading cause of vision loss.⁸
9. Seeing halos: If you see halos around objects, it may signal developing cataracts or night vision problems. These halos are usually more pronounced in the dark and surround objects.⁸
10. Eye pressure: If you feel pressure behind the eye, it may be a sign of developing glaucoma. No need to panic, though, because it’s highly treatable. Pressure buildup can damage the optic nerve that transmits images to your brain, but not everyone who experiences eye pressure has glaucoma. Still, you should get it checked.⁸

While the presence of one or more of these symptoms doesn’t necessarily mean you have a vision problem, we recommend having an eye exam as a precaution. It is essential to have an eye doctor examine your eyes to understand what’s causing these changes. It’s the only true way to find out if you need glasses, and to improve your power of observation.

Just as your primary care physician may listen to your heartbeat and check your blood pressure to monitor your heart rate, your eye doctor examines your eyes to get a clear look into your cardiovascular system. In fact, the eye is one of the only areas of the body where doctors have an unobstructed view of blood vessels. A full eye examination may reveal the first signs of serious heart conditions, including high blood pressure, before symptoms show up elsewhere in the body. And if not managed effectively, many of these cardiovascular conditions can lead to vision loss, too.

As part of your exam, your eye doctor may examine the retina to view small changes in the blood vessels in the back of the eye. This test can detect more serious diseases and is painless and noninvasive. Recent advancements such as digital retinal imaging enable your eye doctor to monitor all the structures of the retina over time.

What your eyes say about your blood pressure

Known as the “silent” disease because its victims often lack symptoms, high blood pressure affects about one in three adults in the United States—while more than one in five people don’t even know they have it.¹ A comprehensive eye exam, however, may uncover early signs of cardiovascular disease.

Your eye doctor can check for subtle changes in the retina that result from high blood pressure, a condition called hypertensive retinopathy.² If your eye doctor sees these changes, he or she can refer you to your primary care physician, who can recommend further testing and treatment.

In some cases, vision loss can occur due to hemorrhages or hypertensive retinopathy. This condition happens when blood obstructs the retina, the eye is deprived of oxygen or the macula (the central part of the eye) swells. Obstruction of the arteries and blood vessels in the retina can be temporary or permanent.³

By maintaining a healthy lifestyle, you can help avoid risk factors that may affect heart health and vision. Take care of your heart and eyes by following these steps:

• Exercise regularly
• Maintain a proper weight
• Eat a heart-healthy diet rich in omega-3 fatty acids, antioxidants and soluble fiber

Consult with your medical doctor before starting any exercise or diet program. And don’t forget to see your eye care professional for regular eye exams. Your eyes and heart will thank you.

1. National Library of Medicine, National Institutes of Health
2. American Heart Association, “Understand Your Risk for High Blood Pressure,” July 2010;
3. Harvard Medical School, “Eye Exams, High Blood Pressure Symptoms & Diabetes Symptoms,” 2005

With health care costs on the rise year-over-year,¹ employers and the government alike have created ways to help families manage medical expenses. One particularly popular program is known as a Flexible Spending Account (FSA). You might also hear it referred to as a Flexible Spending Arrangement.

Either way, FSAs allow you to funnel pre-tax dollars into an account to be used for qualifying health expenses, like copays, deductibles and most prescriptions – including glasses and contacts. The rate of allowable deductions is set by the IRS and may vary by tax year; for 2018, it’s $2,650.² Plus, you can apply extra discounts to qualifying FSA purchases to save even more.

While FSA seems simple, understanding the ins and outs can help you get even more out of the program.

Your FSA Checklist:

• First things first. Check your FSA guidelines to understand what purchases qualify.
• Premium optical retailers fill up fast, so you’ll want to schedule an appointment early.
• Keep a record. You may need to provide receipts, so hold on to necessary paper work.

How do FSAs Work?

At the beginning of your plan period, you’ll set how much you want to contribute to your FSA. Some employers choose to contribute to FSAs, too. Check with yours to see what’s available.

What counts as a medical expense?

Qualifying expenses vary by plan, so you’ll want to start there. Broadly, medical expenses are defined as the costs of prevention, diagnosis and treatment of disease affecting any part of the body.³ Beyond medical services, they may encompass necessary costs for equipment, supplies and diagnostic devices.⁴

For vision, this may include:⁵

• Eye exams and prescription glasses (even name brand frames like those carried at LensCrafters®)
• Contact lenses and maintenance materials (like saline solution)
• Eye surgery to treat defective vision (think Lasik)

Can I Use My FSA Dollars for Everyone in My Family?

Yes. You may use FSA dollars for yourself, your spouse and dependents you’ve claimed on tax returns (visit IRS.gov for the run down).6

Does FSA Money Roll over from Year-to-Year?

Generally, FSAs are use it or lose it, though some arrangements can include a grace period up to 2 ½ months after the end of the year, or a $500 reimbursement for the following year.⁷ They may not include both. It’s also not required of employers, so confirm your specific arrangement.

What about Receipts?

Many FSAs provide debit cards to use when making your qualifying purchases. This makes it helpful to keep track of how much you’ve spent. Make sure to keep your receipts, though, as the IRS may ask for them.

With FSA, Don’t Delay

There’s always an end-of-year rush to use FSA dollars, which means your favorite optical shops will probably fill up fast. If it’s time for your eye exam or you need a new pair of glasses or contacts, make sure to schedule your appointment as soon as possible. And don’t forget to check around for last minute deals and savings to maximize your FSA even more.

1. Historical. Centers for Medicare & Medicaid Services, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html. Accessed October 2018.

2. 2018 FSA contribution cap rises to $2,650. Society for Human Resource Management, https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2018-fsa-contribution-limits.aspx. Accessed October 2018.

3. Publication 501 (2017), Medical and Dental Expenses, Internal Revenue Service, https://www.irs.gov/publications/p502#en_US_2017_publink1000178851. Accessed October 2018.

4. Ibid.

5. Publication 502 (2017), Medical and Dental Expenses. Internal Revenue Service, https://www.irs.gov/publications/p502#en_US_2013_publink1000178885. Accessed 2018.

6. Publication 969 (2017), Health Savings Accounts and Other Tax-Favored Health Plans. Internal Revenue Service, https://www.irs.gov/publications/p969#en_US_2017_publink1000204185. Accessed October 2018.

7. Publication 969 (2017), Health Savings Accounts and Other Tax-Favored Health Plans. Internal Revenue Service, https://www.irs.gov/publications/p969#en_US_2017_publink1000204185. Accessed October 2018.

Let’s face it, Medicare is complicated. If you help out parents or family members who are on Medicare age (65+) or under 65 due to a disability with their health care, you owe it to yourself and them to do an annual check to make sure their plan is appropriate to their needs. You can change Medicare plans during Fall Open Enrollment from October 15-December 7.

Medicare plans may not stay the same, and neither do your parents or loved ones. Because premiums may increase and benefits may change, your parents or loved ones may be paying more than necessary or not getting the types of services they need or want. 

Once a person is signed up for a Medicare plan, they will be automatically enrolled each year.  But it’s a good idea to check annually to make sure the coverage is what is needed. The decision should be based on several factors such as the beneficiary’s overall health, travel habits, medications and which plans include their doctors. 

For starters, there are two broad choices for coverage. One is Original Medicare, which covers hospitalization (Medicare Part A) and outpatient services such as visits to the doctor (Medicare Part B). Original Medicare does not include prescription drug coverage, so you’ll have to enroll into a separate prescription drug plan. You can add a Medicare Supplement Insurance plan (Medigap) to Original Medicare to reduce the cost of co-pays and deductibles for Medicare-covered expenses.

The other choice is a Medicare Advantage Plan, which is offered by private insurance companies that are approved by Medicare. These plans are required to offer at least the same benefits as Medicare Parts A and B, and may include additional benefits, such as routine vision or dental benefits, or prescription drug coverage.

• Medicare Part A (Hospital Insurance) typically is free for anyone who has worked at least 10 years (or 40 quarters) and paid Medicare payroll taxes.
• Medicare Part B (Medical Insurance) has a monthly premium. If your loved one is receiving Social Security or Railroad Retirement Board benefits, the Medicare Part B premium is automatically deducted from your benefits payment. Even people who have a Medicare Advantage Plan pay the Medicare Part B premium plus whatever the premium is for a Medicare Supplement Insurance plan (Medigap) or Medicare Advantage plan. Additionally, with Original Medicare, you’ll need to help your loved one select a prescription drug plan, which has an additional cost.

While all of this is may sound confusing, you as a Union Plus member have a trusted resource to help determine what plan is best to fit you or your loved one’s health care needs.

Union Plus has teamed up with eHealth which is a company that has been assisting people in finding the right Medicare solution since 1997. They have an A+ rating from the Better Business Bureau (BBB) and have licensed insurance agents available to walk you and your loved one through your options and costs. 

Because eHealth works with many insurance companies across the country and use licensed insurance agents, you can rest assured that they will present unbiased options to help in your decision making.

Medicare Fall Open Enrollment is happening October 15-December 7. It is the perfect time to review the options available to your parents or loved ones to determine whether or not it is time to change. This service is free to Union Plus members with no obligation to enroll.

Call 888-719-0689 (TTY 711) to speak with a licensed insurance advisor.

Monday to Friday from 8am-8pm EST

Check out options online
using a plan comparison tool

Albuquerque Teachers Federation (AFT Local 1420) member Meredith Bunting grew tired of paying high monthly Medicare supplement rates. A fellow AFT member recommended exploring her options through the Union Plus Retiree Health Insurance Program¹, which Bunting did during the open enrollment period.

“I wanted to see if I could find a better plan than the one I had, and the representative recommended a Medicare Advantage plan that a friend had also recommended,” Bunting recalled. 

The Union Plus Retiree Health Insurance Program partners with Medicare.com, powered by eHealth, to help union members and retirees—and their Medicare-eligible family members—navigate Medicare plan options and choose the plan that best suits their needs. There is no additional cost for using the Union Plus service, and there is no obligation to enroll in a plan.

“I was amazed that I don’t pay a monthly premium with the plan I found through the Union Plus service,” Bunting said. “I was paying $109 per month with my previous plan. Now, I don’t pay anything.”

Union members and other eligible program participants can find and compare plans over the phone or online. The program has licensed insurance advisors who can provide needed information over the phone and help participants assess plans based on their individual concerns. 

The online recommendation tool allows participants to enter their budget and health needs information and then shows a comparison of plans in the applicant’s area based on monthly premiums and annual deductibles, as well as copayments and coinsurance for various services. 

“It’s been a good plan so far, and I really appreciate the help I received through the Union Plus Retiree Health Insurance Program,” Bunting said. “Using this service from my union made everything so much easier.”

Learn more about the Union Plus Retiree Health
Insurance Program or call 1-844-725-0814 (TTY Users 711).

Many people may find themselves becoming financial caregivers of a loved one as that loved one ages or experiences a life changing event. In this module, we will review what that relationship might look like, including a variety of legal structures to consider. We will cover financial accounts that may be involved, and provide next steps for those who are ready to move forward with the process of committing to a financial caregiver.

Ready to Learn More?

Watch our Becoming a Caregiver module. It's quick and easy. Simply click the yellow button at the bottom of this page. The module will start playing as soon as you arrive on the site. Once you've listened to the introduction, click the arrow to the right of the screen to move through the three different topics:

• Legal structures
• Roles and responsibilities
• How to plan ahead

Tips

Once you've started the module, you can see captions, adjust volume and pause the module by using the controls at the top right of the screen. You can also select the transcript button to see all of the content from the module.

Check out the Becoming a Caregiver Module Now

There are several programs that are available to Medicare beneficiaries to help save money on your prescription drug costs. These include Extra Help and State Pharmaceutical Assistance Programs (SPAPs). There are also resources available for union members through Union Plus.

Extra Help

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If your monthly income is up to $1,538 in 2018 ($2,078 for couples) and your assets are below specified limits, you may be eligible for Extra Help. 

Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help, because certain types of income assets may not be counted. If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help. 

The Extra Help program pays for your Medicare Part D premium up to a state-specific benchmark amount. It also lowers the costs of your prescription drugs. People with Extra Help have a monthly Special Enrollment Period (SEP) to enroll in a Part D plan or switch between plans in 2018. In 2019, Extra Help gives you an SEP to enroll in or switch Part D plans once per quarter in the first three quarters of the year (January through March, April through June, and July through September).
 
Finally, Extra Help eliminates any Part D late enrollment penalty (LEP) you may have if you delayed Part D enrollment. Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance.
 
If you do not have Medicaid, SSI, or an MSP, you can apply for Extra Help program through the Social Security Administration using either the print or online application (If you have Medicaid, SSI, or an MSP, you should automatically be enrolled). Be sure to complete the entire application and provide accurate information so you receive all the benefits for which you qualify.

State Pharmaceutical Assistance Programs (SPAPs)

State Pharmaceutical Assistance Programs (SPAPs) are programs offered by many states that can help residents pay for prescription drugs. Each program works differently. 

States may coordinate their drug assistance programs with Part D. Some SPAPs require that you sign up for Part D coverage in order to qualify for assistance. In these cases, if a prescription drug is covered by both your SPAP and your Part D plan, both the amount you pay for your prescriptions plus the amount the SPAP pays will count toward the out-of-pocket maximum you have to pay before reaching catastrophic coverage. 

Many SPAPs continue providing coverage during your Part D plan’s coverage gap. Your SPAP may also help pay for your Part D plan’s premium, deductible and copayments. 
 
Certain states have qualified SPAPs. Qualified SPAPs provide a Special Enrollment Period (SEP) to allow you to enroll in or make changes to your Part D or Medicare Advantage coverage. Contact your State Health Insurance Assistance Program (SHIP) to find out if your state has an SPAP, if you may be eligible, and how to apply. If you do not know how to contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org.

Assistance for Union Members

If you do not qualify for Extra Help or an SPAP, but want to save money on prescription drugs, check out the instant savings you or your family can enjoy through Union Plus. There is no cost to download and use the savings card as a union member at thousands of participating pharmacies nationwide.

If you need help in finding a Part D Medicare plan or have any questions about health plans available to you, please contact the Union Plus Retiree Health Insurance Program. The program has Medicare Insurance advisors who can help you compare plans and costs available to you among thousand nationwide. Call 1-888-719-0689 (TTY 711) Monday - Friday from 8 am to 8 pm EST to speak with a licensed insurance representative trained in dealing with union members or visit unionplusmedicare.org for more information.

*Much of this content is from the Medicare Rights Center.

 

10 Medicare Questions to Help You Prep for the Medicare Advantage and Prescription Drug Annual Election Period (AEP)

1. How much coverage do I need?
   Not everyone’s coverage needs are the same. How often do you see the doctor or specialist? Do you use prescription drugs on a regular basis? Do you have any medical conditions that require ongoing care? Be honest about your monthly and annual medical needs.
    
2. What can I expect to pay in terms of premiums and out-of-pocket costs next year? 
   You want to be an informed Medicare shopper. Once you’ve picked a plan, look back at your estimates of what you can afford and what kind of coverage you think you’ll need. Does the plan you’ve settled on meet those criteria?
    
3. What can I afford per month, or in an emergency? 
   You’ll want to factor in your income, from work (if applicable), Social Security, IRA and 401(K) savings, and other sources. Compare this with your regular expenses, including how much you may pay monthly toward prescription drugs. What can you realistically afford in terms of monthly premiums? What kind of deductible could you afford if you had a medical emergency? 
    
4. Can I save money by switching to a different Medicare prescription drug plan? 
   It’s always worth checking to see if there’s a better plan for your needs, as prescription drug plans can change from year to year. Our licensed insurance agents can review your current prescriptions and see if there’s a better match for your needs. You could potentially save hundreds by switching to a plan optimized for the medications you take. 
    
5. Is my agent recommending plans based on his or her commission? 
   You want to work with a licensed insurance agent that represents multiple insurance companies and can give you a broad range of choices. At eHealth, our agents are commission-blind and don’t get paid differently based on which plans they sell. 
    
6. Should I look at a stand-alone Part D plan or a Medicare Advantage plan with Prescription Drug coverage? 
   You can enroll in a stand-alone Part D prescription drug plan to go alongside your Original Medicare Part A and Part B and layer supplemental plans on top of that to cover the gaps. Or you can look at Medicare Advantage plans which effectively replace Parts A and B and often provide prescription drug benefits too. Different rules apply for different plans, you can explore these choices with a licensed insurance agent. 
    
7. How can I avoid gaps in my Medicare coverage? 
   Make sure you understand where and when you may be responsible for out-of-pocket expenses, and what your limits of those expenses may be. For any given Medicare plan you’re considering, ask your agent what the worst-case scenario may look like when it comes to out-of-pocket costs. 
    
8. How can I make sure my preferred doctor is accepted? 
   Some Medicare plans utilize specific networks of medical care providers. Make sure you understand whether any new plan you’re considering will also cover your preferred doctors, or whether you’ll be required to switch. 
    
9. Are there any specific benefits I do or do not need? 
   Do you need dental or vision coverage? Some Medicare Advantage plans provide these kinds of benefits. Others may offer complimentary memberships with local wellness programs and fitness centers. 
    
10. Will I need coverage in more than one location? 
    Many people on Medicare like to travel, and some will spend half the year in the north and half in the south. If you like to travel, you should know that some plans rely on specific networks of doctors and hospitals. Make sure that you’ll have the coverage you need wherever you may be.

Medicare has neither reviewed nor endorsed this information.
 

When it comes to protecting your skin from the sun, your options are limitless. Sunscreen comes in lotion, spray or stick form. UVA and UVB filters. Waterproof, sweat-proof, anti-aging, hypoallergenic. SPF 15 or SPF 50. You name it — the list goes on.

But sunscreen is not designed for your eyes (at least not yet). It’s still just as important to protect your eyes from the sun’s harmful rays as it is to shield your skin.

Ultraviolet rays can lead to numerous health problems — ranging from eye cancer to pink eye. They can also cause cataracts, photokeratitis (a kind of sunburn of the cornea) and pterygium (a white or creamy fleshy growth on the surface of the eye).

Most of us realize that staring into the sun for long periods of time isn’t good for our long-term vision. But its rays actually reach our eyes in a variety of ways. Fresh snow, for instance, reflects as much as 80% of UV radiation, which means we can damage our eyes even by looking down. Sea foam reflects about 25% of UV radiation and dry sand about 15%. Even grass, soil and water reflect UV rays.

Researchers estimate we receive 80% of our lifetime exposure to UV rays before age 18. Why? When compared to their parents, children have larger pupils (allowing more light into their eyes) and clearer lenses. Plus they’re outside more frequently and for longer periods of time, and typically without eye protection.

What should you do to protect your eyes? Here are 5 tips:

1. Know when the sun is strongest. Myth buster: the highest UV radiation exposure for eyes and skin is actually in the morning and mid-afternoon, rather than at noon. Sun exposure to the eyes tends to be more continual in fall, winter and spring when the sun is lower in the sky.

2. Wear the right lenses. Don’t skimp when it comes to sunglasses. Choose high-quality sunglasses with adequate UV protection to help reduce glare from protective surfaces. Target Optical® offers stylish and budget-friendly prescription sunglasses for both kids and adults with UV protecting polarized lens options.

3. Choose the right frames. While most sunglasses can help block UV rays from entering through the lenses, pick a frame style with ample coverage like wrap around sunglasses.

4. Double up. Wide brimmed hats don’t protect from UV rays that reflect up from pavement, sand, water, etc. — so be sure to also wear UV-blocking shades.

5. Use the right contacts. Contacts that protect against UV rays are classified into two categories: Class I and Class II. Class I UV-blockers provide the greatest measure of UV protection. Talk with your eye doctor about the best UV-blocking contact lens options for you, and then shop around for the best deals.

So the next time you’re applying sunscreen, make sure you’re following these guidelines as well. Your sight might just depend on it.

Can you have both private insurance and Medicare? With more and more Americans over age 65 still working, coordination of benefits between Medicare and private insurance companies is fairly common. Over 9 million Americans over 65 were working as of January 2017, according to the United States Bureau of Labor Statistics. Some of these people have both private insurance and Medicare.

How Does Coordination of Benefits Work If I Have Both Private Insurance and Medicare?

Sixty-five is the age most people first become eligible for Medicare. Depending on the type of insurance coverage you had when you first became eligible for Medicare, you may be able to choose to have both Original Medicare and private employee (or union) health insurance. Original Medicare generally includes Part A (hospital insurance) and Part B (medical insurance).

Understanding how Medicare works when you have employer-sponsored or retiree health benefits may help you figure out your medical bills.  It’s important that you tell Medicare about your other insurance so Medicare and your other insurance can coordinate benefits. You do this when you first sign up for Medicare by completing the Medicare Initial Enrollment Questionnaire.

With Coordination of Benefits, Who Pays First?

When you have Medicare and private insurance, the “coordination of benefits” process helps determine who pays first.  You might have multiple “payers.”  The insurance that pays first is the primary payer. Your primary payer pays your medical bills up to the amount allowed by your coverage. Your secondary payer may pay for some portion of the services, and there still might be a balance for you to pay.

Sometimes, coordination of benefits may have Medicare as the primary payer, and your private insurance as the secondary payer, as in the following examples:

• You are at least age 65, are still working, and have group health plan coverage through an employer with fewer than 20 employees.
• You are at least 65 and covered by a retiree health plan through your former employer.

Sometimes, coordination of benefits may have Medicare as the secondary payer, and your private employer-sponsored group plan as the primary payer, as in the following examples:

• You are at least age 65, are still working, and have group health plan coverage through an employer with 20 or more employees.
• You’re under 65 with a disability, and you’re covered by group insurance by an employer with at least 100 employers.

What Else Do I Need to Know About Coordination of Benefits Between Medicare and Private Insurance?

Coordination of benefits generally works this way: when Medicare is the primary payer, Medicare generally pays covered benefits once you have met your Medicare deductible before your employer sponsored coverage contributes. Your employer-sponsored group health plan may then pay its portion of the covered services not paid by Medicare as long as those services are covered by the group plan. When Medicare is the secondary payer, the employer-sponsored group health plan may pay any services covered by the plan before Medicare pays its portion of the Medicare-covered services.

Again, even when the primary and secondary payers help pay your bill, you may have an outstanding balance due. How much they might pay depends on what’s covered by your plan and what costs Medicare is responsible for covering.  For example, if Medicare is the primary payer and your employer-sponsored group health plan is the secondary payer and you have met your Medicare deductible, Medicare may pay 80% for most Medicare-covered services.  If your group health pays 80% for services covered by its plan, it may pay the other 20% of the bill, or it may pay only 80% of the remaining portion, leaving you to pay a small balance.  How much the secondary payer pays for covered services depends upon its rules of benefit coordination.

How Might Signing up for Medicare Affect Coordination of Benefits?

What about signing up for Medicare while you still have employer group insurance? One decision you might face is whether to take both Medicare Part A (hospital insurance) and Part B (medical insurance).

Some people sign up for Medicare Part A when they first become eligible, because you typically don’t have to pay a premium for Part A if you’ve worked at least 10 years while paying Medicare taxes. However, if you have a high-deductible plan, like a Health Savings Account (HSA), and you sign up for Part A while still working, you might not be able to make contributions to your HSA plan. So before you decide whether to enroll in Medicare Part A, you probably want to find out how it works with your current plan.

You typically pay a monthly premium for Medicare Part B (medical insurance), so some people who still have employee coverage choose to delay enrolling in Part B until they no longer have employee coverage. However, employers with fewer than 20 employees may require you to take Part B when you turn 65. Talk with your employee health plan representative to find out how your plan works with Medicare.

Please note that many people are automatically enrolled in Part A and Part B, but that typically happens when you’re already receiving retirement benefits from Social Security when you become eligible for Medicare.

If you sign up for Medicare while you’re still covered by private insurance from your employer or union, coordination of benefits usually becomes necessary so that your medical costs may be covered, and aren’t accidentally paid twice for the same service.

Questions About Medicare and Your Private Health Insurance?

It may be a good idea to talk with your employee or retiree plan benefits representative before making your initial Medicare enrollment decisions.

You can call the Medicare Coordination of Benefits Contractor at 1-800-999-1118 (TTY 1-800-318-8782) 8:00 AM – 8:00 PM ET, Monday through Friday to get answers specific to your situation or if your situation changes. You’ll need to provide your Medicare number and one additional piece of information, such as your Social Security number or address, when you call.

If you have questions about coordination of benefits between Medicare and other insurance or your Medicare coverage options, I’d be happy to answer your questions. You can request a phone call or an email with information by clicking the appropriate link below. You can receive immediate, personal help by calling me or another Medicare.com licensed insurance agent at 1-844-847-2660 (TTY users 711) Monday through Friday, 8:00 AM – 8:00 PM ET. To see a list of plans in your area, click the Compare Plans button below.