fbpx

With terms like “employer insurance”, “Medicare”, “Part A”, “Part B”, and “Medicare Advantage” being thrown around, making sense of how employer coverage and Medicare work together can feel incredibly confusing. This article will explain the essential things you need to know about keeping employer insurance and signing up for Medicare to ensure you have comprehensive healthcare coverage.

How does my employer coverage impact when I can enroll in Medicare?

One of the most important factors that determine when you can enroll in Medicare is whether or not you have active employer coverage. If you or your spouse is still working and covered by an employer insurance company, either through their own or a spouse’s current job, you may be able to delay signing up for Medicare without penalty. Those with employer coverage may want to keep that coverage rather than qualify for Medicare in order to take advantage of the often lower premiums, deductibles, and network of providers accepted by their employer health plan.

Will I have to pay premiums for Medicare if I have employer Health Insurance?

If you are still covered by an employer health plan, either through your own or a spouse’s current employment, you may qualify for premium-free Medicare Part A hospital insurance and you likely will not need to enroll in Medicare Part B medical insurance which has a standard monthly premium. This is because in most cases, your employer plan will be considered the “primary payer” while Medicare is the secondary payer. This means your employer private insurance pays claims first before Medicare pays anything.

When should I sign up for Medicare if my employer has less than 20 employees?

If your employer, or your spouse’s employer, has less than 20 employees, Medicare eligibility works differently. In this case, Medicare would be considered the primary payer regardless of your age. So for those employed by a company with fewer than 20 employees, it’s important to sign up for Medicare Parts A and B during your Initial Enrollment Period around your 65th birthday to ensure proper coordination of benefits. This is because your employer insurance would be secondary and only cover costs after Medicare.

Will my employer Insurance change if I enroll in Medicare?

In most cases, enrolling in Medicare when turn 65 will not change or impact your employer health coverage. Your employer group health plan will remain your primary coverage and handle claims first, with Medicare filling in as a secondary payer to cover any additional out-of-pocket costs. Some employers may even subsidize your Medicare Part B premium to keep your total healthcare costs lower. Be sure to check with your benefits administrator on how enrolling in Medicare may affect your specific employer coverage.

What happens if I am eligible for Medicare but delay enrollment?

You have the option to delay signing up for Medicare without penalty past your Initial Enrollment Period if you have active employer coverage through either your job or a spouse’s job. However, if you choose to delay Medicare enrollment due to having employer coverage, you’ll need to enroll in Medicare during a Special Enrollment Period within 8 months of when your job-based health coverage or that of your spouse ends. Otherwise, you may face a penalty for late enrollment into Medicare Parts B and D if you don’t sign up when first eligible.

How does Medicare Advantage Plan fit into employer coverage?

Many people eligible for Medicare choose to enroll in a Medicare Advantage Plan which is an alternate Medicare Plan offered by private insurers that provides Part A and Part B benefits. Some employers even offer coverage through a Medicare Advantage group plan to retired employees. These group Medicare Advantage Plans can help coordinate benefits with the employer coverage, acting as your primary insurance to save you money on premiums and out-of-pocket costs. So in summary, Medicare Advantage is fully compatible with keeping your employer coverage as your primary insurance.

What happens if I have to drop my employer coverage?

Unfortunately, there may come a time when you lose your employer-sponsored health insurance, such as if you leave your job, your employer ends coverage, or your spouse stops working. In these cases, Medicare would then become your primary coverage instead of your former employer plan. For this reason, it’s critical that you enroll in Medicare Parts A and B during a Special Enrollment Period within 8 months after losing your job-based health coverage. If not, you could face penalties for late Medicare enrollment down the road.

Do I need to enroll in Medicare Part D if I have drug coverage?

prescription drug coverage, but you’re still eligible for Medicare, you may want to compare your current drug coverage to Medicare Part D Plans. Part D coverage may provide better cost savings or coverage on prescription medications. Those with employer coverage should check whether their plan provides “creditable coverage”, which is equivalent to standard Medicare drug coverage, before deciding whether Part D is needed. If not creditable, Part D enrollment is recommended.

In summary:

  • Understand when Medicare becomes your primary vs. secondary coverage based on employer size
  • Sign up for Medicare during Initial or Special Enrollment Periods to avoid penalties
  • Medicare works alongside many employer plans without disruption to insurance coverage
  • Consider Medicare Advantage as an alternative to Medicare Parts A, B and D
  • Compare drug coverage through your employer to Medicare Part D Plans
  • Enroll in Medicare promptly if losing job-based health insurance to stay protected

Navigating how employer coverage and Medicare work together takes some education but can ensure continuous comprehensive health insurance coverage in retirement. Consult a licensed insurance agent or your State Health Insurance Assistance Program for personalized guidance on your Medicare enrollment options.

We’re Here to Help

You do not have to spend hours reading articles on the internet to get answers to your Medicare questions. Give the licensed insurance agents at Glidden Group a Call at (208) 962-0077. You will get the answers you seek in a matter of minutes, with no pressure and no sales pitch. We are truly here to help.

FAQS

Can I keep my employer insurance and Medicare coverage?

If you or your spouse is actively working for an employer with 20 or more employees, you may be able to delay Medicare enrollment and keep your employer coverage as primary by contacting your employer’s benefits administrator. Medicare would become your secondary insurance.

What happens if I have coverage through an employer but am also eligible for Medicare?

If your employer has 20 or more employees, your employer insurance plan is primary while Medicare is secondary. However, if you or a spouse delay Medicare due to employer coverage and then retire, Medicare is the primary on the first day of the month after retirement.

How do I enroll in Original Medicare if I have employer coverage?

Contact your benefits administrator to inform them of your Medicare eligibility and ensure your employer coverage remains primary. Then apply for Medicare Parts A and B through the Social Security Administration. You cannot delay Medicare enrollment indefinitely while keeping employer coverage primary.

Will I lose my employer health benefits if I enroll in Medicare?

No, enrolling in Medicare does not require you to drop your employer health insurance. In fact, keeping both types of coverage is a good option as it coordinates your benefits and ensures your medical costs are covered whether you’re working or retire. Contact your employer for details on how the plans coordinate.

My employer coverage ends next year, when should I enroll in Medicare?

If you are already eligible for Medicare due to your age (65+) or a disability, enroll in Medicare during Special Enrollment Period within 8 months after your employer coverage ends. You want Medicare to kick in as soon as possible to avoid penalties for late enrollment and gaps in coverage if you get sick.

Can I enroll in Medicare Part D prescription drug coverage if I have creditable drug coverage through my employer?

You can delay Part D enrollment if your current employer drug coverage is considered creditable, meaning it’s equal to or better than Part D coverage. However, make sure to enroll in Part D during a Special Enrollment Period within 63 days of when your employer drug coverage ends to avoid penalties.