Medicare Eligibility: Facts and Myths

Until recently in Massachusetts municipalities could not force their employees onto Medicare, unless they adopted chapter 32B section 18 of MA General Laws. This, in turn, often made for steep claims for the Groups who were self insured, as well as the fully insured plans that continued to have rising premiums. However, with the passing of the MA Health Care Reform Law, enacted in July 2011, if you are age 65 and eligible for Medicare you must sign up; no more staying on your employer’s plan forever!

Who is eligible for Medicare?

  • You or your spouse is over age 65
  • You or your spouse has worked at least 10 years and is eligible for Social Security benefits
  • You have Lou Gehrig’s disease or ESRD
  • You are under age 65 and receive disability social security benefits and meet other conditions

Facts about Medicare

  • Medicare Part B now covers preventative screening services, such as Mammograms, Diabetes testing and cancer screenings
  • All Medicare participants are eligible for a free yearly wellness visit
  • You’re protected by a new law that revokes enrollment of providers and suppliers who engage in abuse of billing privileges

Myths about Medicare

  • Medicare is ending with the implementation of the Affordable Care Act (ACA), commonly known as Obamacare.
  • You will not be able to continue to see your current doctor.
  • Seniors on Medicare must buy more insurance to comply with the ACA.

With my experience over the years, and speaking with different Cities and Towns throughout Massachusetts, convincing their retirees who are eligible for Medicare to switch from the active plan to Medicare has been a daunting process. The retirees often think they will not receive the same benefits as before, or have the mentality of “why fix what’s not broken?”

Yet, seniors need not be intimidated by making the switch. In conjunction with Medicare, seniors are often offered a Medicare supplement plan by their employer, such as Medex (BCBS of MA) or Medicare Enhance from Harvard Pilgrim Health Care. This will ensure that the individual will receive the same benefits they are used to in their active plans. Also, now more than ever, Medicare plans are offering more coverage options with the implementation of the ACA so the service will continue to improve.

If you’re in charge of a self-funded plan and want your retired employees to make the transition to Medicare, there are free counseling services available from the state to help them through a program called SHINE. More information is available on the website.


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