Healthcare benefits are important to you and your family’s health, and are essential to your family’s financial well-being. One catastrophic medical bill can have dire consequences to a family’s finances. Let’s look at where you can purchase medical insurance at all stages of your working and retired life.
You are working and have not reached age 65
If you are not yet 65, or eligible for a Social Security disability benefit, you are not eligible for Medicare. In order to get healthcare coverage, you will need to purchase an active healthcare plan. Many individuals have health benefits offered through their employer in which the cost is shared by the employee and employer. Employers may offer a tier of plans with differing benefits, such as deductible levels, types of services covered, and maximum out-of-pocket costs. Be sure to review the plans and costs available to you in order to choose a plan that works for you. You should also review the plan's Summary of Benefits and Coverage to understand the plan's coverage and your out-of-pocket costs.
- If you are an active cleric or a lay employee of The Episcopal Church, see Medical Plans for information about the healthcare plans offered by the Medical Trust. You can also speak to your diocesan administrator about the plans offered.
- If you are not eligible for coverage through the Medical Trust, check with your spouse’s employer about the benefits offered.
- If you, your spouse, or partner is not offered employer-sponsored health benefits, check out the Government’s Health Insurance Marketplace to find a plan that is right for you. Depending on your income, you may be eligible for a subsidy from the government that can be used to help pay for the cost of health coverage.
Medicare-Eligible and Retired
If you are age 65 or over and retired, Medicare is your primary insurance if you have earned at least 40 credits in the Social Security system. Part A, inpatient hospital care, is free, and Part B, doctor care, has a monthly cost prorated based upon income. Go to www.medicare.gov to learn more about the specifics of Part A and B.
There are many gaps in the coverage of Part A and Part B, including very limited prescription drug coverage. Thus, individuals on Medicare often purchase a Medicare Supplement insurance plan, also called Medigap insurance.
- If you receive a benefit from a pension plan sponsored by The Church Pension Group, you may be eligible to participate in the Medicare Supplement Health Plan offered by the Medical Trust. See Medicare Supplement for information the Medical Trust’s Medicare Supplement Health Plans and your eligibility.
- If you are clergy, you may also be eligible for a Medicare Supplement subsidy depending on the amount of Credited Service you earned under The Church Pension Fund Clergy Pension Plan before retirement.
- If you are not eligible for the Medical Trust’s Medicare Supplement Health Plans and wish to compare the Medical Trust’s Medicare Supplement Health Plans with others offered in your area, go to the Medicare website to get information about the different Medigap plans.
Medicare-Eligible and Still Working
If you are age 65 or over, working full-time and covered under your employer's group health plan, you may not need to sign up for Medicare Part B. Medicare Part A becomes a secondary payer. However, there are some rules of which you should be aware.
If your active plan is a high deductible health plan with a Health Savings Account (HSA), you may not have contributions made to the HSA once you have Medicare Part A.
To understand your situation, you should contact your employer or talk to Medicare’s Benefits Coordination and Recovery Center at (855) 798-2627.
Tips & Resources - Healthcare Benefits
If you are working in retirement, be sure to understand the Medicare Secondary Payer rules, which may require your employer's active plan to pay primary and Medicare to pay secondary. There are exceptions to this rule for small employers who are eligible to participate in the Medical Trust's Episcopal Health Plan for Qualified Small Employer Exception. See information about Working While Pensioned and Medicare Secondary Payer coverage. Call Medicare at (855) 798-2627 if you have questions.
Call Medicare to sign up for Medicare Part A and have a discussion about whether you need Part B. If you have a high deductible health plan with HSA contributions, discuss the rules about contributions once you have Part A.
Be sure to sign up for Part B at the appropriate time. You may be charged back payments, penalties, and, potentially, increased Part B premiums if you don’t. See Social Security and Medicare for more information.