![]() If one of the companies in the group is "large", then the entire group can be considered large. Sometimes the employer may be part of a group of companies with a common insurer. If your employer tells you that they will be primary to Medicare, then it really doesn't matter how many employees there are.Ī company with fewer employees can still offer the same benefits to older employees if they wish, but don't have to by law. One can defer Part B without penalty if the EGHP is primary to Medicare. The question to ask of the company benefits folks is whether the employer group health plan (EGHP) will be primary or secondary payer to Medicare when you turn 65 and keep working. There are laws that require employers to give the same benefits to those 65 and older as they do to younger employees when the employer is "large" (20 or greater-no disability 100 or greater with disability). you bring on as many as you can and spread the risk and the cost. If they can do this for the sickest part of the population, why can't they offer it to healthy people who need insurance? That's how insurance works. With a medicare advantage plan my copays are lower, my $3000 of insulin is covered for about $75, and the only med they didn't cover is available almost as cheap with coupons. Three months ago I was paying BCBS $900/mo and happy to have it. I'm upper-middle income and somehow I qualified for a NO-PREMIUM Humana Advantage policy that fills in most of my gaps. The simplest for me was medicare with a medicare advantage plan. There are four or five other types of coverage you have to consider - your meds, your 20% copay on everything, your yearly deductible and donut hole. Sign up to receive the latest health and wellness information right to your inbox here.And the $148 just gets you very basic coverage with TONS of shortfalls and it will leave you with big bills. Coinsurance is when you and your plan both share a percentage of the cost of a service that adds up to 100 percent.įor more information on common health care terms, use this helpful glossary. For example, if a medical service has a 20 percent coinsurance, you would pay 20 percent of the cost and your plan would pay the other 80 percent. What is coinsurance?Ĭoinsurance is when you pay a percentage of the cost for an item or service. If your plan had a $0 prescription drug deductible, your plan would help pay for your prescription drug costs without you having to pay a certain amount first. For example, if your plan had a $200 prescription drug deductible, you would pay the first $200 of your prescription drug costs before your plan helps to pay. There could be a deductible on medical services or on prescription drug services, but not all plans have a deductible. What is a deductible?Ī deductible is the amount you pay for a service before the plan shares the cost of the service with you. ![]() Your plan may have a $0 copay for seeing your doctor, for example, in which case you would not have to pay a copay each time you visit your doctor. You may not always have a copay, however. Copays cover your cost of a doctor’s visit or medication. What is a copay?Ī copay is a fixed amount you pay for a health service, seeing your doctor, or filling a prescription. All three are different types of cost sharing, which is the portion you pay for a medical service or prescription drug. The most common types are copays, deductibles, and coinsurance. But when it comes to payment types, it’s helpful to know the meaning of the different terms so you know what form of payment is required.
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