Employee Benefit Pros Should Add Medicare and Social Security To Their Knowledge Arsenal - Part 1 (Medicare)

Medicare Card

Many employee benefit professionals working in the private sector know little about the federal Medicare and Social Security (SS) programs. This is probably true of public sector and not-for-profit pros too... And that's unfortunate because employees have a lot of questions about both programs. They see deductions from their pay for these programs and assume HR can provide answers to their Medicare and SS questions. They quickly learn that they are on their own in navigating these benefit programs that seem an extension of what their employer currently provides.

Of course it is not the employer's job to counsel employees on their Medicare and SS options but why not help provide a basic understanding of the programs. If the concern is legal liability, don't give advice. If the concern is fear of providing the wrong information, make sure you know what you are talking about before you open your mouth and always include a verbal or written disclaimer. And if the concern is that Medicare and SS benefits are not your area of expertise, don't claim that it is and study up.

Medicare 101 For Benefit Pros

Benefit pros don't need to know everything about Medicare, but they should have a very good understanding of these five basic Medicare features.

1) Who is eligible to receive Medicare benefits and when. U.S. citizens or permanent residents age 65 and over, young people with disabilities, and those with end stage renal disease. In general, eligibility requires paying Medicare (FICA) taxes for 40 quarters (ten years).

2) How and when to apply for Medicare. Individuals who are age 65 AND receiving a Social Security check are automatically enrolled in Medicare and will receive a Medicare card in the mail. If they are not receiving a SS check, they must contact the Social Security office (yes SS handles Medicare so they are called SS offices) to enroll.

3) What to do about Medicare if an employee is age 65, works full-time, and enrolled in their employer's health plan. Enroll in Medicare Part A when first eligible. He or she can delay enrolling in Medicare Parts B and D. Contact SS to enroll in Medicare Part A and discuss delaying enrollment in Parts B and D.

4) What are the different parts of Medicare and what care do they cover. The Medicare program consists of four main parts:
• Part A (primarily covers hospital (inpatient) care);
• Part B (primarily covers physician services (outpatient) care);
• Part C or Medicare Advantage (private health insurance elected in lieu of Parts A and B);
• Part D (standalone prescription drug program for individuals enrolled in Medicare Parts A and B or enrolled in a Medicare Advantage plan that does not have prescription drug coverage)

5) What are Medicare Supplement plans and how do they work. Individuals who enroll in Medicare Parts A and B (aka original or traditional Medicare) can purchase a Medicare supplement plan to cover expenses not paid by Parts A and B. Individuals enrolled in Medicare Advantage plans cannot purchase a Medicare supplement plan.


Benefit pros can decide how much detailed information they want to provide about Medicare. Employees will ask questions and they greatly desire your guidance, so why not give it to them. Be careful of the information you provide and always recommend that they speak with a Medicare counselor regarding their specific situation.

2014 Medicare and You booklet - (
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