Will Medicare cover everything my current employer plan does?
Answered by 61 licensed agents
Answered by Dana Dane on April 3, 2025
Agent Licensed in OR, AZ, CA & 6 other states
Answered by Mark Bilgere on February 16, 2026
Broker Licensed in TX, AR, IN & LA, MN, NE & OK
Danny Brechin
Contact me.
Answered by Daniel Brechin on September 11, 2025
Agent Licensed in AL, FL, KY, MS & TN
Lt Col Tim Brown
Contact me.
Answered by Lt Col Tim Brown on August 20, 2025
Broker Licensed in TN, AL, CO & 10 other states
Good evening, this is Charise Karjala with Health Markets Insurance Agency at my office in Palm Desert, California. This question reads, "Will Medicare cover everything my current employer plan does?" That's a great question, and it's pretty hard to answer without knowing how old you are, what your Medicare eligibility is, and what your options are within your finances.
But I will say this: employer-sponsored plans or individually family plans have carve-outs or additional benefits that may be different from Medicare's. In the case of some employer-sponsored plans, I think of Starbucks, for example. They have cut coverage for certain procedures that insurance companies and Medicare do not approve of, and it's considered to be an employee benefit. So think in vitro fertilization or some LGBT procedures. Those are two that would be covered but aren't really appropriate for Medicare beneficiaries, if you know what I mean.
So let me say this: Medicare, at the end of the day, if you have Medicare as a secondary, which is a gap policy, there's no insurance company between you and Medicare. There's only you and the CMS regulations and Medicare to administer them. As long as your doctor is doing the diagnostics and the coding correctly, there's no insurance company to say prior authorization or not approved or needs a second opinion or a flat no. If it's approved by CMS, the markers are all hit, you've got the appropriate protocol, then there's no reason for it to be denied.
So the question, "Will Medicare cover everything my current employer plan does?" Yes, and maybe more easily. So think about that one.
Answered by Charise Karjala on May 12, 2025
Broker Licensed in CA, AZ, CO, PA & WA
Will Medicare cover everything my current employer plan does? That's a great question to ask before you make any decisions. What we do here at my State Farm agency on Kelly Street in Manchester, New Hampshire, is we get the plan documents from the current employer. They send it to us, we take a look, we see what they cover, we see what the deductibles are, we see what the limitations are, then we bring our client in and say, here's how this would compare to original Medicare parts A and B. But then we also talk about adding a Medicare supplement, which would cover all of the gaps and limitations in original Medicare. Do your homework for us, work with someone like myself who deals with this every single day and can give you great information so that you can make good decisions. I love that question, I'd be glad to help.
Answered by Tony Capraro III on May 29, 2025
Agent Licensed in NH & ME
Answered by Ronnie Robinson Jr on January 5, 2026
Broker Licensed in FL, AL, GA & 9 other states
When you meet with a trusted Medicare Broker, make sure you have all of those details so you can compare what your specific Employer plan covers and what Medicare plan options cover in your state/county.
Answered by Christy Jones on August 24, 2025
Broker Licensed in ID, AL, AR & 20 other states
Even if your employer pays for your premiums the coverage when you use it , is typically far superior. The network of doctors is very very large. I
Answered by Tasha Riggs on April 12, 2025
Broker Licensed in CO, AZ, HI & 10 other states
Both programs are regulated by state and federal laws as it relates to plan design, benefits, and protection.
In fact, most of our clients have reported that the Medicare benefits have been better than their employer offered plans and often is a lower out of pocket cost for better coverage.
If you would like to learn more about Medicare or get help comparing the risks/out of pocket cost for healthcare between an employer plan and Medicare; a local, trusted, Medicare agent can help you compare and contrast the two programs and provide you with the information you need to make an informed decision.
Answered by Steven Litzsinger on November 17, 2025
Broker Licensed in MO & IL
Answered by Cody Biggs on December 11, 2025
Broker Licensed in LA, AL, AZ & 24 other states
Medicare consists of several parts, each covering different aspects of healthcare:
• Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
• Part B (Medical Insurance): Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
• Part C (Medicare Advantage): An alternative to Original Medicare, offered by private companies approved by Medicare. Provides all Part A and Part B benefits and may include extra benefits like vision, hearing, and dental.
• Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs.
Employer-sponsored health plans typically provide a broader range of coverage options, including:
• Medical Insurance: Comprehensive coverage for doctor's visits, hospital stays, and medical procedures.
• Prescription Drug Coverage: Often includes a wider range of medications and lower co-pays.
• Dental and Vision Insurance: Coverage for routine dental exams, cleanings, vision tests, glasses, and contact lenses.
• Additional Benefits: Wellness programs, gym memberships, mental health services, and other perks.
While Medicare offers extensive medical and hospital coverage, it may not include all the benefits that an employer-sponsored plan does. Carefully comparing the two can help you determine the best path forward for your healthcare needs.
Answered by Mark Cunningham on May 19, 2025
Agent Licensed in CO, FL, GA & NE, VA, WI & WY
A: HOSPITAL
B: DOCTORS.
No prescription drugs unless administered by a doctor.
That is why the majority of people on Medicare get:
1) Medicare Supplement or Medi-Gap plan.
Or
2) A Medicare Advantage (Part C) plan.
3) A Prescription Drug (Part D) plan.
They fill in, when combined with basic MEDICARE usually much mire than the coverage you are getting from your employer.
Of you have any questions, feel free to contact me direct and I can answer more specific questions you may have.
My assistance is complimentary, their is no fee.
Answered by Daniel Maisel on May 12, 2025
Broker Licensed in CA, AZ, MI & NV, OH, TN & WA
Answered by Joanna Finnegan on August 6, 2025
Broker Licensed in ID, AR, AZ & 31 other states
Answered by Eddie Tune on September 8, 2025
Broker Licensed in MO, AL, AR & 20 other states
Answered by Michael Caldwell on May 20, 2025
Broker Licensed in IN, AL, AR & 31 other states
Answered by Allen McGirl on May 12, 2026
Broker Licensed in CO, AL, AZ & 34 other states
Answered by John Burke on March 30, 2026
Broker Licensed in FL, GA, IA & 18 other states
Answered by Bryan Monteagudo on February 16, 2026
Agent Licensed in FL
Answered by Steven Bleicher on May 30, 2025
Broker Licensed in AZ
Answered by Andrew Zurbuch, MBA on March 11, 2026
Broker Licensed in IN, FL, KY, MO, OH & TN
Answered by Steve Houchens on December 29, 2025
Agent Licensed in KY & TN
Most employer Plans are very similar to Medicare Advantage Plans, so they would be the best comparison that your Broker can help you with.
Answered by Jim Tretola on October 13, 2025
Broker Licensed in NJ, CA, CT & 6 other states
Answered by Timothy Brown on April 8, 2025
Broker Licensed in PA, CT, DE & 15 other states
Answered by Kristen Skinner on February 16, 2026
Broker Licensed in OK
Answered by Barbara Barnes, CMIP® on April 3, 2025
Agent Licensed in PA
Answered by Yasmery Vargas on April 18, 2025
Agent Licensed in PA
What does Medicare cover and not cover? To answer this question, we need to take a look at the two different parts of Medicare. Medicare has Part A, which is your hospital coverage, and Part B, which is your medical coverage. Part A, typically, people do not pay a premium for unless you did not work for at least 40 quarters within your lifetime. Part A is going to cover your inpatient hospital care, some skilled nursing care, and hospice care. There is a deductible of $1,676 every time you go in the hospital. If you're there more than 60 days, there's a copay of $419 per day from day 91 to 150. It goes up to $838 per day. Then after that, you will be paying for everything as it is not covered.
For skilled nursing facility care, Medicare will cover you for the first 20 days. Then after that, it's $209.50 per day up to day 100. After day 100, you're not covered, so everything will be out of pocket. Your Part B covers your doctor services, your outpatient services, including surgery, and some other services and supplies that are not covered by Part A. There is a premium for your Part B. Most people will pay $185 per month, but it does go up based on your income. Part B has an annual deductible of $257. Then after that, 20% is what your co-insurance would be.
There are two different types of plans that you can get: Medicare Supplement and Medicare Advantage to cover the things that Medicare does not cover. If you still have questions or need any help applying for our plan, please feel welcome to give me a call. I am licensed in every state and DC.
Answered by Chad Watkins on May 29, 2025
Agent Licensed in NJ, AK, AL & 48 other states
Answered by Leslie Helene Sussman on April 7, 2025
Broker Licensed in NJ, FL & PA
Answered by Hannah Skinner on July 10, 2025
Agent Licensed in SC, AL, AR & 44 other states
Answered by Diana Salisbury on April 16, 2025
Broker Licensed in OH, IN & MI
Answered by Jason Vallejos on June 9, 2025
Broker Licensed in CA, AZ, CO & 17 other states
Answered by Christopher Garcia on August 4, 2025
Broker Licensed in NM, AZ, CO & TX
Answered by Cathy Barnett on June 4, 2025
Broker Licensed in TX, AL, NC & SC
Answered by Hudson Albert on June 1, 2026
Broker Licensed in TN, AL, AZ & 20 other states
Answered by Tracy Corwin on March 23, 2026
Agent Licensed in OR
Answered by Deidre Wilhelm on August 23, 2025
Agent Licensed in OH & WV
Elaboration:
Coordination of Benefits: When you have both Medicare and employer-based coverage, the plans coordinate their benefits to determine who pays first and second.
Primary vs. Secondary Payer: The employer plan is generally the primary payer if you work for a company with 20 or more employees, meaning it pays first. Medicare becomes the secondary payer, covering any remaining costs for covered services.
Employer-Based Coverage as Primary: If you work for a company with 19 or fewer employees, Medicare typically pays first, and the employer plan is the secondary payer.
Out-of-Pocket Costs: Even with both plans, you may still have out-of-pocket costs like deductibles, copayments, or coinsurance.
Medicare Coverage: Medicare covers most medically necessary services and supplies in hospitals, doctors' offices, and other healthcare facilities. However, it doesn't cover everything, such as routine physical exams, eye exams, and most dental care.
Employer Plan Benefits: Employer-based plans often offer benefits beyond what Medicare covers, such as prescription drug coverage, dental care, and vision care.
Importance of Coordination of Benefits: Understanding how Medicare and your employer plan coordinate benefits is important for ensuring that you receive the most appropriate coverage and minimize out-of-pocket costs.
Answered by Fred Manas on May 14, 2025
Agent Licensed in NY, CT, DC & 7 other states
Answered by Vachik Chakhbazian on July 24, 2025
Agent Licensed in CA, AL, AR & 22 other states
Medicare supplement plans are your best option
It also you can go any doctor. You're not locked into any particular Network like you are today with your employer plan. Any doctor takes Medicare will take your Medicare supplement plan by law
Medicare advantage plans are not your best option and are similar to your employer plans, but they have high Max out of pocket annually which the negative part of it
Answered by Gary Henderson on May 11, 2025
Agent Licensed in TX, AK, AL & 46 other states
Answered by Meghan Blankenship on November 25, 2025
Broker Licensed in FL, MD & OH
Answered by Suzanne Lamperti on August 14, 2025
Broker Licensed in MD
Answered by Todd Bostic on December 22, 2025
Broker Licensed in TX, AL, AZ & 12 other states
Brokers Make a Difference. Find a local insurance agent who brokers several companies and let them help.
Answered by Dean Chiapetto on November 5, 2025
Broker Licensed in VA, MD, NC, TN & WV
It is best to consider a local Agent to review possible "gaps" in coverage. And to make sure your plans fits your personal needs, and concerns
Answered by Pat Papson on September 20, 2025
Agent Licensed in NM
Answered by Carol Conner on October 19, 2025
Broker Licensed in TX
I would suggest you contact an agent, like myself, to allow us to do a need analysis to find the correct plan for you.
Original Medicare, Medicare Advantage, Medicare supplement.
Answered by Rodolfo Rojas on June 1, 2025
Broker Licensed in NV, AL, AR & 36 other states
Answered by Joseph Peck on June 2, 2025
Agent Licensed in MI, AL, CO, KS & TN
Answered by Glenn Alterman on April 20, 2025
Broker Licensed in TX, AZ, CA & FL, NJ, OH & TN
Answered by Dominic Javier on August 4, 2025
Broker Licensed in TX
Answered by Michael Gilman on April 27, 2026
Broker Licensed in NY
Answered by Jessica Ellis on October 2, 2025
Broker Licensed in OK
Answered by Daniel Keane on June 2, 2025
Agent Licensed in TX, FL, MI & NC
Your employer plan (if it's with 20+ employees) usually covers a broader range of services.
You could have things like Dental, Vision, Hearing, better prescription coverage, wellness perks and things like this. Additionally, group plans have other riders that you may have purchased like cancer plans, critical illness riders and accident plans or life insurance that is not covered by Medicare.
Medicare is strong on the Hospital and Doctor side but does not match all in one feel of a group plan. Additionally, Medicare leaves gaps for things like Home Health care, confinement care and many other things that you should at least educate yourself on.
Answered by Ted Sims on January 26, 2026
Agent Licensed in GA
Answered by Rene Casanova on June 16, 2025
Broker Licensed in TX
Answered by Alexis Pepple on September 22, 2025
Broker Licensed in CO, AK, AL & 38 other states
Answered by Janelle Brown on September 27, 2025
Agent Licensed in AZ & VA
For this reason we always recommend a detailed review of employer coverage to include the costs associated with that coverage and compare it with what Medicare would provide. In many cases, Medicare offers more and better coverage for less money. If that is the case, we would recommend staying with the employer coverage until you plan to retire.
A personal evaluation for each situation is always avisable so you or someone you know is facing this situation, have them reach out to us and we can review your situation for no cost or obligation.
Answered by Mike Sosso on May 13, 2025
Broker Licensed in TX, AZ, NC & SD
Answered by Collette Rance on October 11, 2025
Broker Licensed in FL, GA, MA & 5 other states
Answered by Anatoli Korosidis on July 22, 2025
Broker Licensed in MA, CT, FL, NC, RI & TX
Answered by Stephen Ashford on May 2, 2025
Broker Licensed in NY, AR, IA & 5 other states
Tags: Coverage New To Medicare Retirement
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