What are the coverage percentages between Medicare and EGHP?

The coverage percentages between Medicare and an Employer Group Health Plan (EGHP) typically operate on an 80/20 basis. This means that Medicare is responsible for covering 80% of the allowable costs after the deductible has been met, while the EGHP covers the remaining 20%.

This arrangement is particularly beneficial for those who are eligible for Medicare due to age or disability, as it allows for a dual coverage system that can significantly reduce out-of-pocket expenses. Medicare serves as the primary payer and the EGHP acts as a secondary payer, stepping in to cover what Medicare does not.

Understanding these percentages is crucial for individuals navigating their health insurance options, as it influences medical costs and helps in planning for healthcare expenses. Furthermore, this aligns with how many insurance policies are structured, making it familiar to those who have dealt with multiple layers of health coverage.