Who is responsible for costs if a person chooses to retain coverage through an employer group plan?

• A. Medicare
• B. The individual
• C. The employer
• D. No one, it is covered under both plans

Answer: (B)

The individual is responsible for costs if they choose to retain coverage through an employer group plan while also being eligible for Medicare. This is because, when an individual opts to keep their employer-sponsored insurance, they are accountable for any premiums, deductibles, and out-of-pocket expenses associated with that coverage.

Even though Medicare may cover certain services, it primarily serves as a secondary payer in this situation, meaning it will only pay after the employer group plan has processed the claims. Therefore, if an individual maintains their employer group coverage in conjunction with Medicare, they cannot expect Medicare to cover those costs while the group plan is in effect, resulting in personal financial responsibility.

This understanding emphasizes the need for individuals to carefully review and consider their options when they are eligible for both Medicare and employer-sponsored health insurance.