- A group health plan is a type of health insurance plan that is offered by an employer or other group, such as a union or professional organization, to its employees or members. Group health plans typically provide coverage for a wide range of healthcare services, including doctor’s visits, hospital stays, and prescription drugs.
- If a Medicare beneficiary has coverage through a group health plan, their Medicare coverage may be different from the coverage that is available to other beneficiaries. This is because Medicare works with certain types of group health plans to coordinate benefits and help ensure that beneficiaries receive the most appropriate care at the lowest cost to them.
- The way in which a beneficiary’s Medicare coverage works with their group health plan will depend on the specific type of group health plan they have. For example, if a beneficiary has an “employer-sponsored” group health plan, that plan is required to pay for certain services before Medicare does. In this case, Medicare may pay for certain services that are not covered by the group health plan, or it may pay for services that are covered
by the plan but that have a cost-sharing requirement, such as a copayment or deductible. - If a beneficiary has any questions about how their group health plan works with their Medicare coverage, it is recommended that they contact their group health plan or speak with a Medicare representative. The beneficiary may also want to discuss the coverage with their healthcare provider to ensure that they understand the treatment options and any potential out-of-pocket costs.
