Toni Says: Medicare rules confuse HR manager

Hello Toni:

I am a human resources manager for a local oil and gas company and have a question about an employee who is turning 65. His situation is a little different because next month he will begin receiving chemotherapy for cancer. I’m not sure how to advise him because technically he is working full-time. He has 5 months of pay from unused vacation time that he can use while recuperating, which will keep his status as a full-time employee.

Our firm has over 100 employees and I have been told there are rules based on company size. How can I make sure that I have the correct answer to my questions on behalf of the employees of our company?

- Katie, Tampa, Fla.

Hi Katie:

Your employee with cancer is approaching his Medicare Initial Enrollment Period, which begins three months before his 65th birthday month and ends three months after his 65th birthday month. Many Americans do not enroll in Medicare when turning 65 because they (or their spouse) are “still working” for an employer with over 20 employees and have employer group health insurance, such as your company. This rule can protect your still-working-full-time employee with health issues.

Now, readers, let us talk about who will pay your claim first. This depends on how many employees are on your company’s group health plan. (See chart on pg. 21 of the Medicare & You handbook on number of employees.)

Katie, below are a few items that can make your HR role job easier:

Readers, there are specific Medicare rules regarding leaving employer benefits after turning 65. Learning when and how to change Medicare plans and which Medicare Part D prescription drug plans best fits one’s health situation is especially vital for an employee such as Katie’s, who has cancer issues.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email [email protected] or call 832-519-8664. Toni’s new book, Maze of Medicare, is now available on www.tonisays.com. Maze of Medicare is the first explanatory book that includes scripture and positive quotes to help relieve the stress and anxiety over transitioning to Medicare.