Medicare Part A Hospital, B Doctor Visits

or my Employer’s Insurance Coverage Group Health Plan?

What about Special Enrollment Periods SEP  when I’m no longer covered by Employer Group Health Coverage?


Medicare & Employer Health Plans?

If you are covered by an Employer Group Health Plan Health Care Advocates Definition, then when you or your spouse turn 65 and 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:

If your Employer Group Insurance has
#Fewer than 20 employees


If you work for an employer who has fewer than 20 employees, Medicare will be primary and pays before your other coverage.   You MUST  sign up for Part A and Part B *  when you’re first eligible.

If you don’t enroll in Part B  when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.  The  Part B General Enrollment Period is quite confusing and unbelievable on how long you might have to wait. 

Medicare vs employer group when there are 

#more than 20  employees

employer certification of group health insurance for medicare

How you delay your Medicare 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 *

Links, Resources & Bibliography


Special Enrollment Period SEP fo Medicare Parts A & B 

When you #lose or give up Group Health Coverage
Watch for the 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.

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:

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 retireCOBRA, 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!


Health Insurance unfortunately is very complicated

President Trump February 27, 2017

Medicare #Enrolling in Parts A & B # 11036


Medicare enrolling in parts a and b


FAQ's from Medicare.Gov 

#Should I get Parts A & B?

Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases,    #How

It depends on the type of health coverage you may have.

#Understanding Medicare Advantage Plans (PDF) #12026

Watch Steve's Video Seminar

Insurance Companies get a fee from the Federal Government, when you enroll in an MAPD plan.  MAPD Plans must cover all A & B services Medicare.Gov *

That's why the premium is very low or ZERO!

Let your Employer know you’re eligible for Medicare A & B


You must tell your employer if you are enrolled, or eligible to enroll, in Medicare (Part A and/or Part B coverage).  Your boss is mandated to tell Medicare who is working there and is eligible for Medicare.

waiver uhc



Medicare Advantage Guaranteed Issue 

When you lose Employer Coverage

guaranteed issue MAPD & Rx loss of employer plan

Our webpage on Guaranteed Issue & Enrollment Periods for MAPD Medicare Advantage & Part D Rx

  • I’ve retired early, I’m not 65 yet  What do I do for Health – Medical Insurance?
    • ***There are plenty of Health Plans in the Individual Market.  Get quotes hereIf your MAGI income is below 400% of Federal Poverty Level you may even qualify for subsidies – tax credits.  Get a complementary quote, benefits, rates & subsidy calculation for California here.   If you are 62+ and getting Social Security some of your Social Security is taxable and counts towards MAGI income for subsidies.  If you are disabled, you get Medicare after two years of SSDI.   If you can really live on a budget or are unfortunately forced to,  there is Medi-Cal if you are under 138% of Federal Poverty Level.  We don’t get paid to help you with that, so just contact Medi-Cal directly.   Check out the Retirement Section of our website.
  • I retired from North Carolina State University july 2018.   They told me that they would supplement my medicare to the same level of medical insurance I had before, but when I asked them how to enroll for that they were less than helpful.   I have social security and they pay a monthly premium  I don’t know whether I am enrolled or what to do to enroll or what exactly I am covered for or what to do.
  • Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?
  • How do I show Medicare that I had qualifying employer coverage?
  • What Happens If I Don’t Take Part B as Soon as I’m Eligible?
    • ***If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you could have had Part B but didn’t take it. You will pay the extra 10 percent for as long as you have Part B.
    • If you didn’t take Part B at age 65 because you were covered under as an active employee (or you were covered under your spouse’s group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan.
  • This is a wonderful service you’re providing and I will be sure to refer my friends to you for their insurance needs.
    • ***Thank you
  • I’m disabled and covered under my Dad’s retirement plan. I just qualified for Medicare. Must I enroll in Part B or can that be postponed as I have employer coverage?
  • I turned 65 a few months ago, I’m still working and I’ve stayed on my employers group plan.    1. If I cancel my current medical insurance, with my employer, then I guess I would need to sign up for Medicare part “B”, right?   2. My income probably falls into the first tier so there would be a premium of $134 +/-   3. Then I would need a Medicare Supplemental plan like my High Deductible F so another premium of $75 or so, right?    4. Then another supplemental Prescription Plan Part D with a premium of around $40    5. Also, my Granddaughter, whom I have legal custody of is on my group plan, so I would need to get individual coverage for her, right?   6. I believe that was around $350 for a plan I liked.   7. So I would end up with an estimated monthly expense of:   Part B Medicare $134   Plan Hi F Medi Gap $75  Part D Rx $40   Individual Plan for Grand daughter   $350   For a total of $599   8. On Medicare Part “B” how would she pay that premium?  A. Monthly bank withdrawal?
    • 1. Yes
    • 2. Correct. Here’s our page for Part B Premiums and the Surcharge on Part D
    • Medi-Gap High F with Blue Shield is explained on our webpage here. Here’s the Plan Details and comparison of what Medicare Pays, what you pay and what the Insurance Company pays.
    • Part D is explained in general on this page. Right now, AARP has the lowest premiums for Part D of the companies that we represent. However, AARP wants to control the Internet and doesn’t allow agents to post anything meaningful, as I hear everytime I go to a Web Design Meetup or anything, CONTENT IS KING! So, you have to email us to get AARP details. [email protected]
    • 5 & 6. Coverage for dependents. You can get quotes here. We need to clarify on a case by case basis as to if an employer plan will cover dependents when the employee is covered by Medicare. In general, they will.
    • 7 Yes, your calculations are correct. $350 for a young child gets you a platinum plan with Blue Shield.
    • 8. Ways to pay Part B Medicare Dr. Visits are in the Medicare & You manual page 27 & 28

#Medicare10050 and You  2024
Everything you want to know 

Steve's video on Medicare & You


your medicare benefits # 101116


Anthem Medicare Supplement

Anthem Medicare Supplement - Get Quotes, Information and ONLINE Enrollment - No extra charge for our help

Just Enter your census or securely send us an excel spreadsheet or a list of employees and get instant proposals for California

employer small group quotes


Schedule a Skype, Zoom, Phone or Face to Face meeting


Links, References & Resources

official Medicare  link  to enroll in Medicare Part A Hospitalization and Part B Doctor Visits.

Learn More ===>


Introduction to #MediGap

Medi Gap Guide to choosing a plan 2023

Our video explaining the Governments brochure on choosing a Medi Gap Policy.  Click the little square on the right, to enlarge the video.

When you enroll beyond age 65 for Part B as you had
Qualifying #Employer Coverage


Termination of Employment or Retirement Plan

You have the right to purchase a Medi-gap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminatesor you lose your eligibility due to divorce or death of a spouse or family member. The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.

Our webpage on the pros & cons of Employer Coverage vs Medicare

Loss of COBRA or Cal Cobra

You are also entitled to this protection when you become eligible for COBRA  (Our webpage on COBRA)  or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health Insurance.  CA HealthCare Advocates *

COBRA and Medicare are VERY VERY confusing.  Double check with us [email protected]  on your specific situation!!!

Situation 4

Guaranteed Issue Loss of Employer Coverage

You received notice of termination, or your coverage was terminated from any employer-sponsored health plan, including an employer-sponsored retiree health plan. This includes termination for loss of eligibility due to divorce or death of a spouse.

Situation  11


situation 11 employer plans


  • You enrolled in an employer-sponsored health plan that supplements Medicare, §419 (e) Welfare Benefit Plans   and either of the following apply:
    • The plan either terminates or ceases to provide all of those supplemental health benefits to you; or
    • The employer no longer provides you with insurance that covers all of the payment for the 20% coinsurance.
  • Why is there Both situation 4 and 11?
  • See our main page on loss of employer coverage

5 comments on “Medicare enrollment, if covered by Employer Plan? Retiring?

  1. I misunderstood and did not file for Medicare part B in time when I retired in June.

    Now Kaiser has terminated my health care retirement benefit. I am enrolling now. [In Part B]

    What options do I have or have I lost retirement health care through Kaiser forever?

  2. Can I keep my group plan with over 20 employees and get an MAPD plan. I want the hearing aid benefits.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.