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The rules for coordinating Medicare with COBRA can be confusing because COBRA looks exactly like your employer's health insurance — you can go to the same doctors, the coverage is the

same, and any money you've spent toward the deductible for the year still counts. But as soon as you leave your job, Medicare becomes your primary coverage and COBRA is secondary. If

you haven't signed up for Medicare, you could face expensive coverage gaps. THE PROBLEM: Even though COBRA coverage looks exactly like your employer's coverage, Medicare rules

don't see it that way. As soon as you leave your job and lose your coverage as an employee, Medicare generally becomes your primary coverage — even if you keep their coverage through

COBRA. If you don't sign up for Medicare when you leave your job, you could end up with big coverage gaps and big bills. Bonnie Burns, a consultant with California Health Advocates,

helped a 68-year-old woman who had health insurance through a large employer until she left her job at age 67. She signed up for COBRA rather than enrolling in Medicare. After she

experienced some expensive medical problems, she received a $150,000 bill from her COBRA insurance company. The insurer argued that it shouldn't have paid the bulk of her claims because

Medicare should have been her primary coverage — even if she hadn't signed up for it. The company ended up dropping the bill after the woman hired a lawyer to write to her employer and

the insurer explaining that she was not adequately notified of the Medicare rules when she left her job. Burns recommends contacting your State Health Insurance Assistance Program (SHIP) as

soon as you lose your job. SHIP counselors can answer Medicare questions, walk you through the enrollment process and help with any problems. "People who are eligible for Medicare

should sign up for Medicare as early as possible during their special enrollment period, when they know they are leaving their job or losing their insurance from current work to avoid gaps

in coverage and potential penalties,” says Casey Schwarz, senior counsel for education and federal policy with the Medicare Rights Center. Some people may not be aware of the importance of

timing when it comes to Medicare enrollment. Last year, Joanne Giardini-Russell, owner of Giardini Medicare in Howell, Michigan, which helps people with Medicare issues and supplemental

coverage, helped a 70-year-old man who lost his job in late May and had coverage until the end of the month. He planned to continue his employer's coverage through COBRA after that

because his wife was undergoing chemotherapy. She had an appointment June 3 for chemo, which generally costs about $13,000. He knew he and his wife had up to eight months to sign up for

Medicare and had been focusing on the eight-month time frame to avoid the late-enrollment penalty. But he didn't realize that they needed to sign up for Medicare right away to get the

primary coverage. Giardini-Russell let him know about the rules just in time for him and his wife to sign up for Medicare and get her chemo covered.