How to Transition from Employer-Based Insurance

How to Transition from Employer-Based Insurance
Medicare health insurance

Aging in America isn't all bad— when every American turns 65 and becomes eligible for Medicare benefits. If you're already enrolled in an employer-sponsored health insurance plan, switching to a different one can be daunting at first.

When is it appropriate to begin looking at plans? Is it necessary for me to notify my employer ahead of time? What is the best way to ensure a smooth transition?

We'll answer all of these questions and more in the sections below. Read on to learn what you need to know about switching from employer-based benefits to Medicare, from how to make the move to working with HR to how to complete the sign-up process step by step.


Making the Change

There are many reasons to move from employer-based health insurance to American Medicare, if you've lost employer coverage after turning 65 or would like the extra benefits of Medicare.

If you're still working, your employer can still have compensation. Alternatively, you could be eligible for compensation from your spouse's employer. You can still enroll in Medicare–in reality, you have a variety of insurance options.

You can opt-out of your employer's plan and sign up for Medicare Parts A and Medicare Part B. You may also retain the employer's coverage when applying for Medicare, allowing the two to work together as primary and secondary providers.

You are not obligated to take Medicare only because you are qualified for it. Another choice is to retain the employer's insurance and apply for Medicare later. Alternatively, you could enroll in only Medicare Part A for extra hospital coverage and then qualify for Medicare Part B when your employer's coverage ends.

As you can see, by switching from employer-based benefits to Medicare, you have a lot of choices.

Will your employer's HR department assist you until you're able to make the switch? Let's take a look.


Also Read: Medicare Plan Terms Employers Need to Know


Will HR be able to assist me in this transition?

HR can assist many workers in navigating the transition and answering any questions they may have.

Setting up a meeting with your HR representative to explore your options and learn more about how often your employer can or may not be involved in the transition is the best way to get started.

The majority of people would switch from employer-provided coverage to a dual-coverage alternative, with employer coverage serving as a backup to Medicare. When you have dual coverage, the insurer will give the bill to Medicare first before sending it to you. Anything not covered by Medicare will be sent to a secondary payer, such as the boss, who will cover the remainder.

Others may elect to replace their employer-provided coverage with a Medicare Advantage Plan or Medicare Supplement Plan, as well as a Medicare Part D plan.

Bring up these possibilities with your HR to see how ready they are to assist.


How to Transition from Employer-Based Insurance


What information do I require?

There's a lot to consider before making the move. These are the measures you'll need to take to move from employer to Medicare coverage, from important dates to notify the right people.

  • Arrange a Meeting: To make the move, you'll need to set a date. For the most part, it's the three-month registration cycle that starts three months before and concludes three months after your 65th birthday. If you wait too long to enroll, your options may be reduced, and you may be stuck with higher coverage costs. Between October and December, you can turn to Part D prescription plans or Medicare Advantage, with an effective date of January the following year.

Learn more: Medicare Enrollment Periods you Need to Know

  • Speak with HR: As previously mentioned, you should always seek advice from your HR department first. If you intend to use your employer's coverage as your secondary payer, ask questions about how it would operate. How much would your out-of-pocket expenses be? Is there a deductible, if there is one. Calculate all of the costs of switching from private insurance to Medicare, including copays, coinsurance, deductibles, and premiums. After that, double-check these numbers with your boss.

  • Choose a Plan: It's now time to choose the Medicare package that's best for you. Here are some choices for you:

  1. Medicare Supplement, also known as Medigap, is supplemental health insurance sold by private providers that can help fill up some of the holes of Original Medicare, such as ambulance costs and other medical expenses.

  2. Medicare Part D - Prescription drug coverage under Medicare.

  3. Original Medicare is a fee-for-service Medicare plan that includes Parts A and B.

  4. Medicare Advantage, also known as Part C, is a private insurance plan offered by Medicare-approved companies that provides all of the benefits provided by Original Medicare and can also include additional services such as dental, hearing, vision, and transportation.


Also Read: Does Medicare Cover Dental Implants?


Inform Your Doctors

Finally, inform your primary care physician and any regular doctors that your coverage has shifted from employer-provided coverage to Medicare. You'll provide them with the information they need to properly bill your insurers.


For More Information About Medicare

Call Medicare



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