Welcome to Medicare – but what about the rest of the family?

by Robert I. Field, Ph.D., J.D., M.P.H.

About to turn 65? Congratulations. You will soon be eligible for one of the best health insurance plans in the world.

Medicare beneficiaries are highly satisfied with their coverage – more so than those with private insurance. And why shouldn’t they be? Traditional Medicare covers almost anything they need and lets them choose any doctor or hospital they want. 

But before relaxing too much, check on a few details. While you will be well protected by Medicare, the rest of your family may not be so fortunate.

What kind of insurance does your spouse have? Are they covered under an employer plan that you have now? If so, they will probably lose their coverage when you join Medicare.

That’s what happened to a San Francisco benefits consultant when his wife turned 65, as reported by NPR. After years of helping others find coverage, he faced the prospect of becoming uninsured himself.

What about your children? Did any of them take advantage of Obamacare to go back under your policy until age 26? They’ll also be thrown off of it when you join Medicare.

If any of your family members faces this predicament, they do have someplace to turn. The COBRA law lets them keep their coverage for up to three years. But only if they pay the full cost of the premiums themselves, including the share your employer has been contributing. That can amount to a hefty sum.

You can also try to solve their problem by continuing to work and keeping your employer’s coverage in lieu of Medicare. But once again, check the details.

If your company has more than 20 employees, you’re fine. But if it is smaller, their insurer can refuse to cover you once you become Medicare eligible. Then no one in the family will have coverage. 

Of course, your spouse and children can look for policies as individuals. The problem is that they may not find any. If they have serious medical problems, or if they have had any in the past, insurers may charge exorbitant premiums or refuse to cover them altogether.

And the process of looking for an individual policy can be daunting. The benefits consultant whose circumstances NPR described was astonished at the difficulty of navigating the system, even for someone as knowledgeable as he is.

Then there is the option of waiting until they have a medical crisis and visiting a hospital emergency room. But, contrary to widespread belief, they will not receive comprehensive treatment in the ER, only an assessment of their condition and medical stabilization. And, to say the least, this is a highly risky and inefficient means of obtaining health care.

The final option is to wait, if you can, until January of 2014. That’s when Obamacare fully goes into effect. Once that happens, any family member regardless of age or medical condition will be able to find an affordable policy on one of the new insurance exchanges.

The bad news is that even under Obamacare, the system will still be disjointed and complex. You will still have to coordinate your Medicare eligibility with the coverage of other family members.

However, the good news is that none of them will be at risk for becoming uninsured. Continued coverage will be guaranteed. 

Opponents have found no end of flaws in health reform. But no one has yet proposed a viable alternative. Isn’t it better that Americans have the reassurance of knowing that neither they nor any member of their family will be shut out of access to health care because of circumstances beyond their control?

Joining Medicare should be a benefit the entire family can share.