Follow correct steps when leaving employer health plan for Medicare

Dear Toni: My husband recently retired from his job, and because I am over 65, I need to sign up for Medicare. I went to the local Social Security office with the proper documents to enroll in Medicare.

I asked the Social Security agent if I needed to do anything else, and he said I was all set. A few weeks later, I received my new Medicare card in the mail with both Medicare Part A and B dates.

It was not until I went to the doctor and had my claim denied that I discovered the old employer insurance was still listed as primary, not Medicare.

The insurance company said I had to call Medicare to change its information, and Medicare said it would take 10 business days to update. What do I do?

I have no coverage because the company insurance is still listed as primary, and neither Medicare nor my supplemental Plan G will pay.

Please help. — Debbie, Sugarland, Texas

Dear Debbie: In the past few weeks, the Toni Says team has received several questions from people whose Medicare claims are being denied after they left an employer’s insurance. When Medicare still lists an employer group health plan as the primary health insurance, that supersedes Medicare and the supplemental policy or Advantage plan.

There is a process for leaving employer group health plans, whether you are the employee or the covered spouse, and enrolling in Medicare. You need to inform Medicare that it should be primary and that you (or your spouse) are no longer covered in an employer group health plan.

Here’s the verification process to determine your primary Medicare insurance:

■ Visit medicare.gov and register for an account once that you or your spouse have a number on your Medicare card.

■ View what is in your Medicare.gov account and verify that the information is correct. With this information, you will be able to see what Medicare is viewing while you are discussing Medicare issues such as which plan has been chosen, prescription drug coverage or insurance claims.

■ If you see the employer group health plan is still listed as primary after you have enrolled, call the Medicare Benefits Coordination and Recovery Center at 855-798-2627 and follow the prompts. Advise the agent that you are no longer enrolled in the employer group health plan. (The change from group health insurance as primary insurance to Medicare is estimated to take 48 hours.)

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.