How do we switch from private to Medicare?

1 answer | Last updated: Oct 28, 2016
A fellow caregiver asked...

A working 68 year old female becomes disabled from a head on collision car accident (she was not cited for the accident). She before October 24, 2009, the day of the accident she was a state tested nurse aide. Previously Anthem Blue Access was her primary insurance and Medicare was her supplementary insurance. Her injuries are Traumatic Brain Injury and left sided paralysis. Now that she is not working how can she switch and have Medicare as her primary insurance?


Expert Answers

If she had both Medicare and health insurance coverage through a large employer while she was still working, the employer-based insurance (in this case, Anthem Blue Access) paid first, with Medicare paying some of the remaining costs. Since she is no longer working, Medicare will become the primary payer, which means that medical bills go first to Medicare. If she also has employer-based coverage as a retirement benefit, that retiree health insurance will become the secondary payer, picking up some of the costs that Medicare doesn't pay. To get more details about how Medicare works in this situation, you can look at Medicare's online booklet Medicare and Other Health Benefits: Your Guide to Who Pays First[medicare.gov].

Medicare's switch to become her primary insurance will eventually happen without her doing anything -- Anthem Blue Access will either cancel her policy or switch it to retirement coverage, and will notify Medicare. But to make things go more smoothly and quickly, she can contact the health insurance or benefits office at her former employer and ask them to notify Anthem and Medicare of the change in circumstances. Once Anthem has ended its employment-based coverage, she can let Medicare know of the change by phoning the Medicare Coordination of Benefits Contractor at 1-800-999-1118. Once she has lost her employment-based Anthem coverage, she should also let her doctors and other health care providers know about the change.