My Medicare only provides minimal coverage out of state. What should I do?

Editor’s Note: Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

I will get to as many questions as I can here, but please accept my apologies that I am not able to answer everyone’s questions.

Holly – N.Y.: My husband and I both have Medicare, and we have separate drug coverage through his old employer. However, our policy provides only emergency coverage when we travel out of state. We go to Florida for four months in the winter. Can you give me some advice as to what kind of Medigap policies are good in our area and where I can look for them for this year’s enrollment?

Phil Moeller: It sounds like you may have a Medicare Advantage retiree health plan. Basic Medicare (Parts A and B) would not limit your insurance when you traveled to other states. I’m also assuming your Medicare Advantage plan has a separate or stand-alone Part D drug plan. Most Medicare Advantage plans have the Part D insurance bundled in with them. You will need to confirm these things.

If you do have a Medicare Advantage plan, you are not allowed to get a Medigap plan as well. It’s illegal for insurers to sell you both plans at the same time.

Your options with a Medicare Advantage plan may be limited. Does your husband’s old employer offer any other type of retiree health coverage? If so, explore this. If not, you may need to consider leaving this plan and either getting another Medicare Advantage plan that does cover you for out-of-state care (there are some policies that do this) or getting basic Medicare (Parts A and B), a stand-alone Part D drug plan and a Medigap policy. If your husband’s former employer has a health reimbursement plan, perhaps it will be willing to provide you the same financial support for your new coverage as it is now doing for your drug coverage.

You can use the Medicare Plan Finder to search for Medicare Advantage and Part D plans. Medicare has a similar tool that will help you evaluate Medigap plans. The costs of basic Medicare are presented here.

Larry – Fla.: I retired from the state of Florida in January and activated Medicare Part B. I compared the various Medigap options with the state of Florida retiree plan, Medicare Advantage and private insurers, but none seemed better than the other. None of them offer decent dental coverage, which should be considered preventive care for good health. Since I’m still healthy, I haven’t enrolled for any supplemental policies for now, but what is your judgement about Medigap coverage?

Phil Moeller: First off, congratulations on doing so much homework. If everyone were as diligent, I’d be out of a job! Medigap, especially letter Plan F, is the closest thing to complete health coverage available under Medicare. You retain the right under basic fee-for-service Medicare to see any health care providers you wish, assuming they accept Medicare. You do need a stand-alone Part D drug plan as well. But with a solid Medigap plan, you really are covered for care anywhere in the U.S. and would also get emergency care outside the country.

Of course, none of this stuff comes for free. You can research Medigap plans here. Be aware that if your guaranteed enrollment window for Medigap has passed, you may have difficulty finding a policy you like at a good price. You can find a good explanation of these guaranteed issue rights on page 21 of Medicare’s annual guide to Medigap.

Lastly, even though you’re in good health now, this is not likely to always be the case. Even healthy aging will entail the need for increasing amounts of health care. So I’d only remind you that these are insurance products. You need them now and may not be able to get them when an adverse health event occurs.

Joe – Ill.: I will turn 65 this July. I already have enrolled in Medicare Part A, but I thought I could remain on my wife’s plan at work (she teaches in a public school), which has covered me since I retired two years ago. Can I be on Part A and be covered by my wife’s Blue Cross and Blue Shield for Parts B, C and D, including doctors’ visits, pharmacy, dental and vision care?

Phil Moeller: Yes. You should be eligible to continue being covered by your wife’s health plan so long as she is actively employed. Taking Part A will not invalidate your participation in this plan.

If your wife is in a high-deductible plan with a health savings account, you cannot make tax-advantaged contributions to this plan if you are on Part A. However, she should still be able to participate in the plan, so the downside could be minimal.

Part A also can be a secondary payer of hospital claims. So if you had such claims and they were not fully covered by your employer policy, your Part A might pick up some of these unpaid expenses.

Lastly, your question implies that you think your wife’s coverage is similar to Medicare when it comes to what you call “Parts B, C and D.” However, it’s not. Basic Medicare (Parts A and B) does not cover routine dental, vision or hearing care. Some Medicare Advantage plans (Part C of Medicare) do cover these items.

Alan – Ind.: I have just turned 65 this week. I am still working and on my employer’s health plan, which is a high-deductible health savings account. The plan is a family plan with a $5,000 deductible with a maximum out-of-pocket cost of $8,000. I don’t plan on retiring for one more year. I understand that neither I nor my employer will be able to contribute to the health savings account if I go onto Medicare. My question is, how would Medicare and my current health plan interact? Would Medicare, as the secondary payer, pay on my current health plan’s deductible and then on my current health plan’s co-insurance? Is going onto Medicare a common strategy for people who also have a high-deductible health savings account?

Phil Moeller: You do not need Medicare when you turn 65 so long as you’re still working and are covered by your employer’s health insurance. You do have the right to get Medicare, either in addition to your employer health plan or in place of it. In most cases, you’re better off financially keeping the employer coverage. But by all means, compare different plans and see which approach is best for you. Should you leave your employer’s plan, however, it can be difficult to resume this coverage later. You would want to know this ahead of time.

If you begin Social Security benefits, you have no choice but to be signed up for Part A of Medicare. This will invalidate your ability to participate in a health savings account. If you do file for Social Security and get Part A, you need not sign up for other Medicare coverage so long as your employer plan is in effect. In this case, Part A can become a secondary payer of hospital claims (that’s what Part A covers). For example, if you had a covered hospital stay, but your insurance did not pay all of the insured expenses, your Part A might pay some or all of these expenses. Part A is premium-free for people who qualify for Social Security benefits.

Owen – Conn.: I am 62 and retired with a good health plan. When I hit 65, should I switch over to Medicare? I was told that it’s mandatory.

Phil Moeller: Nearly all retiree health plans switch from being the primary to the secondary payer of health claims when you turn 65. So for practical purposes, Medicare will be mandatory at that time. You should check with your plan administrator on the details and timing.

Following Up #1:

I wrote about a financial adviser whose client and her husband had run afoul of both Social Security and Medicare. The government linked their Social Security numbers and the woman’s effort to file and suspend her Social Security somehow led to her losing her Medicare coverage! As the old Ripley’s “Believe It or Not” stories used to say, we can’t make this stuff up, folks.

Her adviser reports that the women’s situation is being straightened out, but that she is still exposed to nearly a month-long period when she will have no Medicare. Let’s pray she remains in good health until her insurance coverage resumes. In the meantime, a Social Security spokeswoman reports that it is not uncommon for two spouses’ Social Security numbers to become linked. Here is what she writes:

In your message, you state that her Medicare is now under her spouse’s Social Security number (SSN).  I can confirm this change occurs when a Medicare only entitlement on a SSN converts to a monthly benefit entitlement on a different SSN.  However, the start date of entitlement to the Medicare coverage on the old record does not change when it converts to the new SSN.

Additionally, a new health insurance card is issued when an individual status changes.  For the card issuance policy and corroboration, see HI 00901.045: Health Insurance Card – Policy and HI 00901.065: Health Insurance Card Issuance.

I include this explanation in full, because A) Social Security has on occasion quibbled with how its comments are translated, and B) you need to see how clearly the agency explains its own rules.

Following Up #2:

Lawrence – Va.: I am confused by your response to Rick of Washington below, which appeared on the PBS NewsHour website, and wondered if the answer is dependent on the state one lives in?

Rick – Wash.: I am retired and will be 65 this November. I am not collecting Social Security at this time. I am also covered by Federal Employees Health Benefits as my insurance plan. Does applying for Medicare and Social Security become more complicated or easier if I am already covered by FEHB?  Do I have to pay for Medicare in addition to my FEHB payments?

Phil Moeller: Your FEHB plan is the exception to the rule that retiree health coverage always pays secondary and that Medicare is thus required. Your retiree coverage should continue to pay primary and you might not even need Medicare. Check with your benefits folks on this. If this is the case, then you need do nothing when you turn 65. Social Security, which administers Medicare enrollment, may send you a Medicare card after your 65th birthday. Assuming you won’t need Medicare, you should decline Medicare and send the card back. . . .

I am a retired federal civil servant living in Virginia and continued my Federal Employees Health Benefits in retirement. I am 66 years old and not collecting Social Security at this time. I was told by the FEHB carrier as well as the Center for Medicare & Medicaid Services in Baltimore, Maryland that once I was covered by Medicare and no longer working, Medicare becomes the primary payer and FEHB becomes the secondary payer.

In addition, I also have Medicare Part B. That is required in order for me to be covered by my retired military health benefit, Tricare for Life.

So my question is about the exception to the rule in your response to Rick from Washington and if it is a law or statute that makes it the exception. And as both the FEHB and Medicare customer service representatives have stated that Medicare is primary and FEHB is secondary, could you provide the exception support?

Phil Moeller: Once you are on Medicare — which Tricare requires you to be — it will be the primary payer for claims, and your FEHB will become the secondary payer. However, FEHB cannot force you to get Medicare, so without the Tricare requirement, you could have avoided Medicare, and FEHB would have remained the primary payer.

Support PBS NewsHour: