Do I need Medicare Part A Hospital, Part B Outpatient or Part D Rx
if I’m covered by my Employer’s Group Health Plan?

Introduction

Medicare & Employer Health Plans?

If you are covered by an Employer Group Health Plan, then you or your spouse turn 65, become eligible  for Medicare Part A Hospital and Part B Dr. Visits, there are several things to look into, check out and make decisions on:

• Does your employer have more or less than 20 employees?
  • If fewer than 20, you MUST sign up for Medicare A & B as Medicare is Primary which means Medicare pays any bills first and if they don’t pay in full, then other coverage you might have, like your Employers Group health plan would pay.  This may also mean, if you don’t have Medicare, you don’t get your bills paid!  If you don’t enroll in Medicare when you are supposed to, there are penalties!
• medicare rights.org/Medicare-and-Current-Employer-Insurance-Scenario  
• Don’t take our word for what’s on these pages.  These complex and confusing rules are not ours, they are Medicare’s, CA State, Insurance Company etc.
  • Follow the links, official brochures and footnotes below for the exact forms and citations you need.  There are penalties if things are done even just a tiny bit wrong.

Jump to section on:

If your Employer Group has
#Fewer than 20 employees

If your employer group has #more than
20  employees

People with group health coverage based on current employment (does NOT include COBRA!)  may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later.

Verify with your HR or benefits manager whether you have group health plan coverage  26 U.S. Code § 5000 – Certain group health plans  Our webpage on the Employer Tax Deduction Section 106 for the premiums paid into a Group Health Plan.  That is, when you retire, decide to go on Medicare, etc., will they be able to certify on form L564 E OMB No. 0938-0787 that you had Group Health Coverage.

How you delay your coverage depends on your situation:

• If you’ll be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you’ll automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday.
•       If you don’t want Part B, follow the instructions that came with the card. If you keep the card, you keep Part B and will pay Part B premiums.
• If you won’t be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you don’t need to do anything when you turn 65.

It’s illegal for an employer to offer any incentives to encourage you to take Medicare and drop the employer plan!  ^Coremarkins *  The Age Discrimination in Employment Act (ADEA) prohibits employers with 20 or more employees from cancelling group health coverage for current employees due to age, even when such employees become eligible for Medicare.  ^SHRM *

Additional Resources:

• Interactive Q & A from IRS on when to sign up for Medicare 
• Centers for Medicare & Medicaid Services employer web page
• Fact Sheet: Medicare decisions for someone nearing age 65
• Fact Sheet: Deciding whether to enroll in Medicare Part A or Part B when you turn 65
• Fact Sheet: Medicare Decisions for Those Over 65 and Planning to Retire in the Next 6 Months
• See our module in the upper right on Should I get A & B?

FAQ’s

• Can I keep my group plan with over 20 employees and get an MAPD plan.
• I want the hearing aid benefits.
• Part B Outpatient & MD, Part D Rx Tax Deductibility?
• Section 106 premiums deductible for employers & self employed

Special Enrollment Period SEP to Medicare Parts A & B 

When you #lose or give up Group Health Coverage
Deadlines!

When you retire, decide you don’t want or lose your employer coverage (COBRA doesn’t count! ^{CA Health Care Advocates})   you may then have an SEP Special Enrollment Period to enroll in Part B Doctor visits, without penalty.   References & Proofs:

• Special enrollment period Social Security Publication # 10012
  • You can use an SEP to enroll in Medicare Part B while you’re still in a group health plan based on current employment. Also, if your employment ends or employer-provided medical coverage ends
• ssa.gov/medSEP
• medicare rights.org/Medicare-Part-B-SEP

If you already have Part A Hospital, you can  enroll online, or  fill out the  #application for Part B  OMB No. 0938-1230 !  and the  Certification from your Employer that you had Group Coverage OMB No. 0938-0787  – L564 E   

Special Enrollment to Medi Gap, Medicare Advantage & Part D Rx

These rules are different and very confusing and hard to explain or understand!  Here’s our webpages on the  special enrollment periods to get:

• Part D Rx and
• enroll in a Medi Gap Plan and
• Medicare Advantage.

If you would like to do a Zoom meeting, here’s our calendar to set it up.

Make sure that your employers Rx Prescription coverage is credible – that is at least as good as the Standard Part D Rx Prescription  coverage so that you don’t get a Part D Rx  late enrollment penalty.

So, basically, as long as you have great coverage at work, just sign up for Part A Hospital and then get Part B, supplements and Part D Rx when you retire.  COBRA, doesn’t count as Employer Group Health Coverage!

Links & References

• Medicare & You Page 26 – Part B Special Enrollment Period.
• brochures & links below or in the right hand column!