Introduction

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:

  • Does your employer’s health insurance plan 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!  You must enroll in Medicare when you are supposed to, if not, there are penalties!
  • Medicare rights.org/Medicare-and-Current-Employer-Insurance-Scenario
  • Don’t just take  our summary.  Medicare’s rules are very complex and confusing.  The 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.

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

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 as defined under  26 U.S. Code § 5000 – Certain group health plans 

See 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 your employer be able to certify on

form L564 E OMB No. 0938-0787 that you had Group Health Coverage.

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

FAQ’s

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!

 

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.

VIDEO Seminar - Introduction to #MediGap

by Steve

Medi Gap Introductory Video

#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!

#Important
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?
  • 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. opm.gov/medicare-part-b-coverage/
  • 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?

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

 

4 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.

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