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Protecting What Matters Most


What Happens to My Family and Staff When I Go On Medicare?

If you are at or nearing retirement, you have probably begun to think about Medicare. But you may also be wondering what happens to my family or my staff if I go on Medicare? If your spouse or dependent children are on your plan, will they lose their coverage? If you are a practice owner with a group policy for your staff, what happens to them when you go on Medicare. This article will help answer those questions.

Protecting Your Spouse and Children

There is no family coverage under Medicare, so if your spouse and children are on your health insurance, you will want to carefully consider which parts of Medicare to sign up for and when. If your family is on your group plan from work, and you plan to keep working past 65, you could decide to combine Medicare Part A with your employer plan to enjoy the best of both. The employer plan would continue to cover your family’s medical needs and it will even help pay some of your medical expenses that Medicare doesn’t cover.

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Combining Medicare and Employer Group Coverage

As long as you have paid Medicare taxes for at least 10 years, Medicare Part A is available at no cost to you. Because it is free and you are entitled to it, most people choose to enroll in Part A when they turn 65. If you are covered by a large employer group plan, with at least 20 employees, you can delay enrolling in Part B. But if you own or work for a small practice with fewer than 20 employees, you may face late enrollment penalties, or not have enough coverage, if you don’t enroll in both Parts A and B when you turn 65.

While you are still working, your employer group plan helps supplement your Medicare coverage. Part A helps cover your inpatient care in hospital or skilled care facilities. Part B covers many of your other health costs such as outpatient care, preventative care, lab tests, and the like. Part D drug coverage helps with the cost of prescription drugs.

When you have Medicare together with an employer group plan, the bills for your care are submitted to both insurance companies. Depending on the size of your group coverage, the employer plan will be either the primary payer or the secondary payer. For groups under 20 employees, Medicare pays first. For larger groups, the employer plan pays first.

Either way, the advantage to your family is that as long as you are working, they could remain under your employer plan and keep their coverage as you transition into Medicare. Once you retire and leave the group plan, they will lose their coverage.

If you are nearing retirement, TMA Insurance Trust can help you and your family members secure the coverage you need. We can help your spouse and children find family and individual coverage for themselves and we can help you find coverage for the expenses that Medicare doesn’t cover. Contact us today for a free consultation.

Protecting Your Staff

If you are a practice owner, you may feel like you have two families. Your family at home and your family at work. Your medical practice staff and their dependents probably have their health insurance through your employer group plan.

When you transition to Medicare, you can keep your group plan in place so that your staff still has coverage. Your group policy has minimum participation requirements, so as long as the remaining employees meet those requirements, your group policy will remain in effect and they and their families will be covered. If your group no longer meets the participation requirements, contact us and we may be able to help your staff members find coverage that fits their needs.

Depending on your policy renewal date, you may even be eligible for a special waiver on those contribution and participation requirements. The waivers are only available from November 1 to December 15 of each year. If you would like to review your plan to make sure you are getting the best rates on group coverage, contact one of our insurance advisors.

Help is Just a Call or Click Away

Transitioning to Medicare is complicated. Not every situation can be covered in this article. But rest assured that regardless of your situation and the type of health insurance you may be looking for, we have one goal: to help provide the best information, advice and service so you can be confident about your choices for yourself, your family and your practice.

Our agents have decades of experience advising physicians across Texas. Our consultations are free with no cost or obligation. Contact us today.

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For over 60 years, TMA Insurance Trust advisors have been serving Texas physicians, their families and staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.

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