How Medicare and Employer Coverage Coordinate

Medicare benefits start at age 65, but many people continue working past that age, either by choice or need. It is important to understand how Medicare and employer coverage work together.

Depending on your circumstances, Medicare is either the primary or secondary insurer. The primary insurer pays any medical bills first up to the limits of its coverage. The secondary payer covers costs the primary insurer doesn’t cover (although it may not cover all costs). Knowing whether Medicare is primary or secondary to your current coverage is crucial because it determines whether you need to sign up for Medicare Part B when you first become eligible. If Medicare is the primary insurer and you fail to sign up for Part B, your eventual Medicare Part B premium could start going up 10 percent for each 12-month period that you could have had Medicare Part B, but did not take it.

Here are the rules governing whether Medicare coverage will be primary or secondary:

If your employer or your spouse’s employer has 20 or more employees, your employer’s insurance will be the primary insurer and Medicare is the secondary payer. If your employer or your spouse’s employer has fewer than 20 employees, Medicare will be the primary insurer and your employer’s insurance will be the secondary insurer.

If you are retired and still covered by your employer’s group health insurance plan, Medicare pays first and your former employer’s plan pays second.

If you receive both Social Security Disability Insurance and Medicare and your employer has 100 or more employees, your employer’s insurance pays first. Some employers are part of a multi-employer plan and if at least one employer in that plan has 20 employees or more, the employer’s insurance pays first. If your employer has fewer than 100 employees, Medicare will pay first.

If you have end stage renal disease (ESRD) and are in the first 30 months of Medicare coverage of ESRD, your employer’s plan pays first. After the first 30 months, Medicare becomes the primary insurer. It does not matter how many employees your employer has.

If you are self-employed and have a group health plan that covers yourself and at least one other person, Medicare pays first. Note that if you are self-employed, you may be able to deduct Medicare premiums from your income taxes by including the premiums in the self-employed health insurance deduction.

If your employer’s insurance is the primary insurer, the employer must offer you and your spouse the same coverage that it offers to younger employees. It also cannot deny you coverage, cancel your coverage once you become eligible for Medicare, or charge you more for premiums, deductibles, and copays.

Short-Term Care Insurance: An Alternative to the Long-Term Care Variety

Short-termA little-known insurance option can be an answer for some people who might need care but are unable to buy long-term care insurance. Short-term care insurance provides coverage for nursing home or home care for one year or less.

As long-term care premiums rise, short-term care insurance is gaining in popularity. This type of insurance is generally cheaper than its long-term care counterpart because it covers less time. Purchasers can choose the length of coverage they want, up to one year. According to the American Association for Long-Term Care Insurance a typical premium for a 65-year-old is $105 a month.

People who can’t qualify for long-term care insurance because of health reasons may be able to qualify for short-term care coverage. This kind of insurance doesn’t usually require a medical exam and sometimes only has a few medical questions on the application. Another benefit of short-term care insurance is that there usually is not a deductible. The policies begin paying immediately, without the waiting period usually found in long-term care policies.

Short-term care policies are not the answer for everyone. They may not cover all the levels of care that a long-term care policy would cover. As with any insurance product, buyers need to make sure that they understand what coverage they are purchasing.  And these policies are not regulated to the same extent that long-term care insurance policies are, so there are fewer consumer protections.

Short-term care policies may be beneficial for individuals who waited too long to purchase long-term care insurance (short-term care can typically be purchased up to age 89). They can also help fill gaps in Medicare coverage or cover the deductible period before long-term care insurance begins paying. The policies may also be appealing to single women because there is no price difference for women and men, as there is for long-term care insurance.  

For more information about these policies from Forbes, click here

Prince’s Public Estate Drama – it all goes to his sister and five half-sisters

It is a pretty sad time for fans of music with the recent deaths of Chris Cornell, David Bowie, and Prince, among others.  These are, in my opinion, some of the greatest creative minds and musical masters the world will ever see.

Prince (Prince Rogers Nelson) was 57 years old when he died last year of an accidental drug overdose.  It appears that Prince had done no estate planning whatsoever.

The Inventory filed by the Personal Representative of Prince’s estate shows $25 Million in Real Estate alone.  Click here to see the actual inventory filed in the Probate Court.  It is likely that his combined real estate holdings will not be his most valuable assets compared to the value of his intellectual property, business interests, and catalog of 50 albums. These things will continue to generate significant revenue for many years. Much of his estate has not yet been valued, but it looks like it could be hundreds of millions of dollars.  The transfer of wealth for estates of this size is usually controlled through trusts and other legal directives.  From Court records to date, which are all available to the public, it appears that Prince did not have any such planning strategies in place.

With no trust in place, Prince’s estate will go through the probate process in the Minnesota court system.  The appointed representatives of the estate will be left to figure out what Prince owned, value each piece of property, pay the income and estate taxes, and distribute the remaining assets to the beneficiaries of the estate.

Prince has one sister and five half-sisters. A Minnesota Court has declared that his estate will be distributed to these six individuals.  While we can’t speculate about how Prince would have wanted his estate distributed, stories of Prince’s charitable nature during his lifetime suggest that he would have probably wanted to leave money to support charities. Stories of his private personal nature also suggest that he would have wanted to avoid such a public display and invasion of privacy.

In any event, if no will or trust turns up, Prince’s estate will be a media drama that unfolds in public.

What if Prince had not died from that drug overdose, but was instead incapacitated and unable to manage his health and financial affairs?  Who would have made decisions for him about his medical care, businesses, and finances? A court, in a public guardianship proceeding, would have had to appoint a guardian or conservator.  This person could have been a complete stranger to Prince.

Estate planning is not just for music icons worth hundreds of millions of dollars.  It is for everyone.  No matter the size of a person’s estate, a comprehensive estate plan will establish control, address incapacity, and direct the transfer assets how, to whom, and when you want.