Covering Medicare Employees in Your Big Business - Zupnick Associates

Having disabled employees on your payroll means that you need to understand covering medicare employees in your big business. Your company must coordinate with Medicare, this is non-negotiable. To learn who may be eligible and how you must comply, read on.

Who is Eligible for Medicare?

Employees likely qualify for Medicare if they are 65 or older. Many younger people also qualify if they have …

  •  Disabilities
  •  End-stage renal disease (permanent kidney failure), requiring dialysis or a transplant.

Employees can see if they’re eligible and learn their expected premium with the eligibility tool.

Covering Medicare Employees in your Big Business: Hospital and Medical Insurance

The Medicare Program includes hospital insurance (Part A) and medical insurance (Part B). Premium-free hospital insurance exists for employees meeting the requirements.

Medicare’s Part A Hospital Insurance

Medicare’s Part A hospital insurance has both premium-free and premium payment options determined by individual situations. It covers

  • Inpatient Hospital care

  • Limited home health services

  • Skilled nursing facility for patients requiring more than custodial care

  •  Hospice care

Premium-Free & Paid Medicare Hospital Insurance

People qualify for premium-free Medicare hospital insurance if they …

  • are 65 or older

  • paid (individually or spouse) ten or more years of Medicare

  • receive, or are eligible to receive, retirement benefits

  •  Social Security (SS)

  •  Railroad Retirement Board (RRB)

  •  had, themselves, or have a spouse who had, Medicare-covered government employment.

Younger people, likewise, can get hospital insurance without premiums if they …

  • Have been entitled to disability benefits for 24 months:

  •  SS

  • RRB


  •  Are kidney dialysis or kidney transplant patients
  • US citizens and permanent residents aged 65+ and not qualifying for free hospital insurance can purchase it.

Medicare’s Part B Medical Insurance

Unlike Medicare’s Part A hospital insurance, Medicare Part B medical insurance always requires payments. It covers medical services and supplies necessary to treat health conditions:

  • Outpatient care

  • Preventive services


      • One-time “Welcome to Medicare” preventive visit

      • Flu and hepatitis B shots

      • Screenings

      •  Cancer

      •  Diabetes

      •  Other benefits (Medicare handbook, “Medicare and You”)

  • Ambulance services

  • Durable medical equipment

  • Part-time or intermittent home health and rehabilitative services, such as doctor prescribed physical therapy

All Beneficiaries Must Pay for Medicare Medical Insurance

Medical insurance requires payment from all benefactors. SS, RRB, and Civil Service retirement checks all deduct these costs. Medicare bills, every three months, the US Citizens or permanent residents aged 65 or older who didn’t pay Medicare taxes.

Medicare’s Part D Prescription Drug Coverage

Medicare’s Part D prescription drug coverage, managed by approved private insurance companies, covers prescription drugs. Its Prescription Drug Plan sets the criteria and breadth of the coverage.

Medicare’s Advantage Plan: Medicare Part A & B Coverage

Medicare’s Advantage Plan Includes both Medicare Part A hospital and Part B medical coverage. Some plans include additional coverage:

  • Dental/vision

  • Hearing

  • Prescription drugs

Covering Medicare Employees in Your Big Business: Compliance

If you have employees eligible for Medicare, your employer-sponsored insurance program must coordinate with Medicare. Requirements vary with the size of your business.

Big Company Medicare Compliance

Big companies (100+ employees) must provide equivalent health insurance options to their disabled Medicare benefactors and other employees. These health insurance options must not reduce coverage or charge higher premiums. Employers function as primary service payers, with Medicare performing as the secondary payer.

Smaller Company Medicare Compliance

Insurance-providing companies employing fewer than 100 people need not provide equivalent health insurance options to Medicare benefactors. They may offer them, their spouses, and dependents supplementary coverage.

Covering Medicare employees in your big business requirements helps you support your disabled employees and keeps it in compliance. Your insurance broker can tell you more.

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