If you are currently employed and will be eligible for Medicare soon, you probably have questions regarding what to do about your health care coverage. The best choice between Medicare and employer coverage depends on your circumstance.
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It can be beneficial to have both Medicare and employer coverage in some cases. In other cases, taking Medicare could make more sense than holding onto an employer’s policy.
First, you must understand how Medicare and employer coverage works together. Then, you can determine which coverage is right for you.
How Does Medicare Work with Employer Insurance?
When you have both Medicare and employer coverage, the size of your employer will determine how your Medicare benefits will coordinate with your employer coverage. If you become eligible for Medicare at age 65 while working for an employer with 20 or more employees, your group plan will be primary, and Medicare will be secondary.
In this scenario, most seniors choose to sign up for Medicare Part A because it is premium-free for those who pay Medicare tax for sufficient quarters. Additionally, if you are currently collecting Social Security Income, you will automatically enroll in Medicare Part A. After 24 months, you cannot collect Social Security Income (SSI) benefits without signing up for Medicare Part A.
If you require care at a hospital, your Medicare Part A benefits will lower your costs. For example, imagine your employer’s group insurance has a $4,000 hospital deductible. In this case, it makes sense to enroll in Medicare Part A for a lower deductible.
For your outpatient and prescription drug coverage, a group health plan from an employer with 20 or more employees is creditable coverage. Coverage creditable for Medicare safeguards you from paying late enrollment penalties for Medicare Part B and Part D when you enroll in the future.
Can I Keep My Employer Health Insurance with Medicare?
Regardless of your employment status, it makes sense to enroll in Medicare Part A as soon as you become eligible. As Medicare Part B requires seniors to pay a premium, you may wish to delay enrollment if you have group insurance. Thus, you can keep Medicare and employer coverage.
The size of your employer determines whether your coverage will be creditable once you retire and are ready to enroll in Medicare Part B. If your employer has 20 or more employees, Medicare will deem your group coverage creditable. On the other hand, if your employer has fewer than 20 employees, coverage is not creditable.
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If you are eligible for Medicare and do not have creditable coverage, you may incur late enrollment penalties. When you leave your group health coverage, the insurance carrier will mail you a creditable coverage letter to provide proof of coverage to Medicare.
Additionally, if you retire and enroll in Medicare and then return to work, you can pause your Medicare Part B benefits and reenroll in the group coverage. Then, you can enroll back into Medicare Part B with no penalties when you retire again.
Medicare and Employer Coverage: Who Pays First?
If your employer has fewer than 20 employees, Medicare becomes primary. Thus, your employer coverage pays second when you have both Medicare and coverage through an employer with fewer than 20 employees.
If your employer has more than 20 employees, Medicare will pay secondary to your group coverage. With small group insurance, we highly recommend enrolling in both Medicare Part A and Part B as soon as you are eligible. If you do not enroll in Medicare once you are eligible, your small employer coverage can refuse to pay your claims. In this case, having Medicare and employer coverage is essential. Thus, we recommend enrolling in Medicare Part B to avoid any gaps in coverage.
Additionally, if you do not enroll in Medicare Part B, you will need to pay the late penalty because your group insurance will not be creditable coverage for Medicare.
Employer Coverage and Medicare Part D
If your employer group insurance includes creditable prescription drug coverage, you can delay Medicare Part D enrollment with no penalty. In this way, it is similar to Medicare Part B.
Having Medicare with this coverage may not be helpful when you have prescription drug benefits through your employer, as the coverages will not work together. Always compare your group insurance to the benefits and cost of Original Medicare + a Medicare Supplement (Medigap) plan + Medicare Part D. Often, it is more cost-efficient and beneficial to leave group insurance and enroll in Medicare, adding a Medicare Supplement plan and a Medicare Part D plan.
Medicare Premiums and Employer Contributions
According to the Centers for Medicare & Medicaid Services (CMS), it is illegal for employers to contribute to Medicare premiums for an employee with Medicare and employer coverage. However, there is an exception for employers who set up a 105 Reimbursement Plan for all employees.
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The reimbursement plan deducts money from the employees’ salaries to buy individual insurance policies. Beneficiaries who participate can receive tax-free reimbursements for their Medicare Part B premium.
A well-known Section 105 plan is a Health Reimbursement Account. An HRA reimburses eligible employees for their Medicare premiums and other medical costs.
Does Medicare Work with Health Savings Accounts?
When enrolled in any Part of Medicare, you cannot contribute to a Health Savings Account (HSA). Likewise, your employer cannot contribute to your HSA once any Part of your Medicare is active.
So, if your group offers an HSA plan when you have Medicare and employer coverage, you are not eligible for the HSA option. If you make HSA contributions past your Medicare enrollment, you can face profound tax implications.
If your spouse has coverage through your group insurance, they can still contribute if their Medicare is not active, and contributions are made in their name. The good news is that you can use the funds saved in your HSA to pay for any medical expenses while you are on Medicare.
What Forms Do I Need to Show Creditable Coverage from an Employer?
You will need your employer to fill out the CMS-L564 form. This form is a request for employment information and will provide proof of creditable coverage to Medicare. Once the employer completes Section B of the form, send in the document with your application to enroll in Medicare. You can avoid the Medicare Part B penalty if you do this correctly.
What Should I Do When Turning 65 and Still Working?
If you plan to continue working past 65, you should determine whether your coverage through your employer is creditable for Medicare before making any decisions. With creditable coverage, you may delay Medicare Part B for as long as you continue to have creditable coverage.
If your coverage is not creditable, it is beneficial to enroll in Medicare with your employer coverage. Either way, we recommend taking Medicare Part A, especially if you are eligible to receive it premium-free.
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If your coverage through your employer is not creditable, you should enroll in Medicare Part B as soon as possible. As stated above, one example of coverage that is not creditable is employer group coverage with fewer than 20 employees.
Unfortunately, many assume that because they have coverage through their job, they do not need to sign up for Medicare, Take Bob, for example. Bob never knew about the Medicare Part B penalty until it was too late.
Before then, he assumed Medicare Part A and his employer coverage would suffice between ages 65 and 70. He thought he would be able to enroll in Medicare Part B normally, with no issues. Watch the video below to see Bob’s story and how to avoid making the same mistake as him.
Can I Delay Medicare Part B After I Retire?
Once you retire, employer coverage is no longer creditable for Medicare. Suppose your employer allows you to remain on group benefits through a retiree program. In this case enrolling in Medicare Part B will avoid the late enrollment penalty.
Once you retire and choose to keep Medicare and employer coverage, Medicare Part B will become primary. Thus, your employer coverage will be secondary. Once retired, many seniors find it more suitable to drop employer coverage and enroll in a Medicare Supplement plan.
How to Transition from Employer Health Insurance to Medicare
It is essential to correctly transition from employer coverage to Medicare to avoid penalties or a lapse in coverage. In many cases, you should not undertake this change alone. It is vital to work with a Medicare expert who has your best interests in mind.
With so many plans to choose from, comparing your best options is key to enrolling in the right policy. At MedicareFAQ, we help beneficiaries switch from employer coverage to Medicare every day. We take pride in knowing our clients are satisfied and confident in their chosen coverage.
To compare the top-rated plans in your area with one of our licensed Medicare experts, call the phone number above or complete our online rate comparison form. We are excited to help you on your journey with Medicare.
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- CMS Forms, CMS. Accessed April 2022.
- How Medicare Works with Other Insurance, Medicare. Accessed April 2022.
- Health Reimbursement, CMS. Accessed April 2022.
- Retiree Insurance, Medicare. Accessed April 2022.
115 thoughts on “Understanding Employer Insurance and Medicare”
my employer pays $500 of my health insurance and i pay 130.00. i have done the research and medicare alone, dropping my employer health insurance is the best option. my question is, can my employer reimburse me for my medicare costs? i know some employers put the amount they were paying for health insurance in an annuity for the employee. any suggestions?
Hi Babr, this is definitely something you would want to speak to your HR department about at your place of employment. Each company handles these situations differently.
I am 84 and have been covered on my wife’s group plans (all credible for Medicare B&D and there have been several over the past 20 years). My wife is going to retire in few months and we will need to both obtain B, D, and Medigap (I already have A was I collect Social Security). We have letters of all the credible coverage except for the period 8/1/12-8/1/14 (2 years) as we have not been able to obtain it from Independence Blue Cross as they cannot locate the information in their systems. I have tried since 2018 since I knew this would be needed someday. I have the ID cards associated with this coverage. I am at a loss as I understand if I do not provide this info a penalty will be incurred for B and D without it. Am I understanding this correctly. I am at a loss of what to do.
Hi Don, Typically Medicare does require the creditable coverage letter as proof of your creditable coverage throughout the years. Because you do have the ID cards for those years you are missing letters, you may be able to send those in as proof of coverage which will be reviewed and determined by Medicare. If they decide you require more evidence of coverage, you may be required to pay the penalty for those years.
Hi, I see that any employer cannot force a current employee to enroll in Medicare. My potential new employer tells employees that once they become 65, they are no longer eligible for group health plan. So, are there exceptions to this law? The employer has over 100 employees.
Also, what about new hires? I am 65+ and currently on Medicare. Can the employer refuse to offer me group health insuance?
Hi Robin, you are correct. Employers are not allowed to “force” you to enroll in Medicare at age 65. Employers with more than 20 employees are required to provide the same health coverage to those over 65 as those under 65. Your employer cannot refuse you coverage due to your age.
I have good insurance coverage with my medical mutual retirement insurance after working 40 years I am retired trying to save money would it hurt to drop my part B Medicare thank you
Merry, the only issue is if you were to drop your Part B now and pick it back up later, you would incur a late enrollment penalty for the time you were not enrolled in Part B.
Hi, my question is, I’ve been retired for a number of years from a large company with retirement insurance and Medicare part A and B. Medicare being primary and retirement coverage being secondary. I have the opportunity to go back to work for a company with more than 20 employees. Can I decline the company insurance and stay with my Medicare primary and retirement insurance secondary.
Bob, you can certainly keep Medicare Part A and Medicare Part B if you decide to go back to work. However, you will need to speak to your benefits administrator from your retiree plan to ensure you will still be eligible for retiree employer coverage while you are working.
I am retired, my husband is not retirement age yet and I have been covered on his employer’s health plan until last August when he left his company. At that time I switched to Medicare Plan B and BCBS Advantage Plan. Due to his income in recent years my Medicare premium is $494 per month + BCBS. He is now going to work for a different company. Someone at Medicare who did not seem very knowledgeable has told me that even if we elect to add me to the new company’s coverage I still have to pay the Part B premium and that Part B would become the secondary coverage. Do I have any option to get off Medicare Part B and just have his employer coverage for now?
Dee, if your husband’s coverage is creditable to Medicare, you can disenroll from Part B and join your husband’s group coverage. Once your husband retires, you can reenroll in Medicare Part B.
I have medicare advantage, now I am covered in my husband job insurance. I suspended part B. Do I have to disenroll from medicare advantage plan?
Marta, MA plans are only eligible to those enrolled in both Part A and B of medicare. If you choose to disenroll from part B then she will no longer be eligible for her MA.
My son was disabled for about 2 years and had insurance from the state when he wasn’t working and was on the ticket to work program when he started back to work. He has been back at work for over a year now and is in no way disabled. SSDI overpaid him by 2 months causing him to reach the 24 months. He is under 30 and had less than 10 working credits earned because of his age when his cancer was diagnosed.
He is thrilled to be back at work, contributing to his HSA and has insurance through work, etc…suddenly they slapped him with medicare telling him he’s enrolled and has been since July of 2021.
He didn’t request Medicare, we notified the state that he no longer needed the medical assistance etc…what do we do? Any suggestions? No one seems to know because everything documented says he shouldn’t get Medicare because he is too young and didn’t have enough credits.
Unfortunately I would not be able to help in this situation. If he was receiving SSD they may have auto-enrolled him due to the 24-month rule, if this was a mistake, my recommendation would be to reach out to Social Security and Medicare to see if they have record of his enrollment and if they can reverse it.
I reached 65 in September, 2021 and enrolled in Medicare Part A. I am still currently employed and have health insurance through my employer. I received an invoice from Centers for Medicare & Medicaid Services for my Medicare Premium Part B. Obviously, if I pay this, I’ll be covered under Part B, but my question is, shall I then cancel my coverage through my employer and sign up for a supplemental plan that is no cost to me?
I am turning 65 in may of this year 2022 and am covered still by my companies health insurance , I have been told to enroll in part a and also told not to . At this point I am very confused as if I should enroll or not.
Yvonne, it is recommended to enroll in Medicare Part A when you turn 65 if you qualify for premium-free Medicare Part A, even if you are still on employer coverage. If your coverage is creditable, you can delay Medicare Part B until you retire or lose credible coverage.
If I am under 65 and disabled and have a Medicare Advantage plan and coverage through my husband’s job (over 100 employees) who is primary and who is secondary? And does that apply to drugs too? For instance if I get my insulin through my DME coverage of my medicare plan because it’s used in a pump can my private insurance through my husband pick up the 20% not paid by medicare?
Kayley, your primary coverage in this situation would typically be the group plan and Medicare would pay secondary. However, it is always good to confirm this with Medicare and your group coverage plan.
If my part A coverage started 4/1/2021, and my part B coverage started 1/1/2022, and I currently have COBRA coverage, can I end my COBRA and enroll in an MAPD PLAN starting 2/1/022. would I have an election of losing employer coverage that I could use for that enrollment?
Great question, Paul! If you drop your COBRA plan, you will have two full months after the month your coverage ends to use your Special Enrollment Period.
My wife is 65 still working, collecting SSA and is enrolled in Part A. The company she works for is a Large Company. She still has coverage with the company plan, and that is how I am covered as well.
I have signed up for Part A as I will turn 66 in Nov 2022 — My wife wants to stop work in May 2022 – and the company plan will be no longer.
Can we both signup for Part B now, and save a “few” dollars on the company plan and then choose a Part C plan w/giveback after were both confirmed on Part B?
RJ, leaving group coverage while working is considered voluntary termination of coverage, if done outside of your Initial Enrollment Period. Depending on your state, you might be eligible for a Special Enrollment Period to enroll into Part B . Once you have your Part B effective date, you can choose to enroll in a Medicare Supplement or Medicare Advantage plan. If your state does not allow this, you will need to wait until she retires and is no longer covered under group coverage.
My husband enrolled in Medicare upon turning 65. Previous to this, his medical insurance was through my cobra from my previous employer. I do not qualify yet for Medicare. I now am back working at a large employer. Can he opt out of Medicare part b if I enroll him in my employer’s plan ( non high deductible/ no HSA) without incurring future penalties upon reenrolling in medicare b when I retire? Would my retirement qualify for the special enrollment period ( 8 months)?
Irene, if your employer plan is considered credible coverage, there is no issue with your husband being on your policy and delaying Part B. I advise you to speak with your plan administrator before making any changes to be sure.
I’m 69, my wife is turned 65 in May, and both have Medicare A & B. We’re also covered by my employer health plan. This last year I took my wife off my employer plan and enrolled her in Medicare Plans D & G, because the plan was lame and wasn’t worth the extra premium, which was about the same is D and G combined. Last month my employer upgraded to a much better plan. We would like to drop Plans B, G and D but are concerned about the consequences years later when I retire, and we enroll again. Plan B is not a problem because I have qualified plan (more than 20 employees). My question is will Plan G be a problem? Higher premiums? Pre-existing conditions? Etc.
Steve, thank you for reaching out. If your employer does offer a qualifying health plan, there will be no issues getting back onto Part B. The issue presents itself with returning to Plan G. When you initially elect Part B, you are given an initial enrollment period where pre-existing conditions are not considered for eligibility. After this initial period, pre-existing conditions would be taken into consideration when applying for a Medigap policy, potentially resulting in a denial of coverage. Also, be sure that your employer plan offers credible prescription coverage as a part of their health plan. This will help avoid Part D Penalties in the future when reelecting coverage.
Jagger, Thanks for your response.
Regarding dropping Part G (my wife’s plan). I was under the impression that dropping B was a total reset and pre-existing would not be an issue upon re enrolling. If so, then is there a waiting period (6 mos.) before part G would grant full coverage? Or should we just keep her on the plan G; and do we have to retain part B as well? (I know, it gets complicated, and expensive).
As for myself, I only enrolled in Part B when I was laid off in 2019 but not D or G because of the cost and I’m healthy for my age. I’m going to get screwed when enroll in Part G later?
One last thing, we did call and had my wife’s D & G policies canceled last week, but now I’m wondering if we can reverse that decision. Filled out the cancellation paperwork on both our part B’s but haven’t sent it in to the SSA yet.
Steve, a waiting period on Plan G is dependent upon the carrier you are applying to. It would be best to speak to a licensed agent beforehand to get the specifics on each carrier and check eligibility. If your wife wants to keep Plan G, she must be enrolled in Part B. As for yourself, you will have to answer underwriting health questions when enrolling into a Medicare Supplement because you are out of your initial enrollment period. If you wish to reverse your cancellations, that would be subject to the carriers. I would contact them immediately to see if this is possible. Be sure to keep in mind the Part B and Part D penalties. If you disenroll from Part B or a drug plan, there could be penalties when reenrolling if you do not have credible coverage.
I am disabled and eligible for Medicare A & B. I am also covered under my husband’s medical insurance (High deductible/more than 20 employees).
My husband contributes to the HSA; I do not.
Are there any limits to my using the HSA until I meet the deductible under his medical insurance or 5o pay outstanding balances on medical bills? My husband’s benefits department says that the HSA is the same as cash.
I was refused Physical Therapy after I used up the insurance benefits; they are aware that I have Medicare, but have not filed a claim. I have asked them to do so since Medicare is considered the secondary insurance. They also told me that I cannot use my husband’s HSA to pay any outstanding bills or for future treatment.
I cannot find any policy which states that I can’t use the HSA as I am not contributing to it.. I called Medicare and they could not find any policy.that limits my ability to use the HSA; other doctors have accepted the HSA all year. They know that I have Medicare,.
Hi Rosina, great question! After enrolling in Medicare, you are still able to use any remaining HSA balance in you or your spouse’s account on qualified medical expenses. Once you have exceeded the benefits allowed by your primary insurance, your doctor will need to reauthorize your need for physical therapy. Medicare should then begin covering these services and you would be responsible for 20% of the Medicare approved amount.
If you are working for a company with more than 20 employees can you drop the company health insurance plan when your Medicare Part A/B starts?
Is there any Medicare rule that says that it is compulsory to stay enrolled in the company plan with more than 20 employees, and require Medicare as the secondary plan? In other words, I want Medicare to be the main insurance and not have to pay premiums for the company plan plus Medicare B and Part D. Thanks
Hi Aj – yes, you can drop your employer coverage for Medicare, regardless of the number of employees. It is not compulsory to stay enrolled in the company plan; the difference is that you won’t face a penalty if you choose to keep a group plan from an employer with 20 or more employees and waive Part B.
My husband dropped his Part B and Medigap F Jan. 1, 2020 because I enrolled him in my employers large group coverage. I’m retiring September 1, 2022 since I turn 65 in August of 2022. I understand that I will automatically be enrolled in Part A and B because I’m collecting social security. Will my husband run into any problems re enrolling in Part B and a Medigap plan?
Diane, he should not run into any problems if he is able to prove credible coverage from Jan 1,2020, to now. He will need to contact the Social Security office when he is ready to reenroll.
In November, I enrolled in part A and B Medicare online. I will be turning 65 in February. Is it possible to drop part B? I work for a company with more than 20 employees. It’s important to me to enroll in Medigap coverage in the OEP. Retirement is a few years away!
Hi Janet – you’ll need to complete CMS Form 1763 and check the box to waive medical insurance.
I’ve had a Medicare Advantage plan for two years. My large employer offers insurance coverage to part time employees based on average hours worked. Last year I was eligible and kept my Advantage plan because I didn’t understand I could have dropped it as well as my Part B. Can I still still drop Part B as I am eligible again this year for employer provided insurance?
Hi Jen – yes, you can waive Part B insurance. You just need to fill out CMS Form 1763 and check off Medical Insurance.
I am turning 65 in 2022. My spouse will not be 65 until 2023. We are currently covered under my spouse’s employer health insurance plan. It is an HSA. My husband contributes to the plan. Can I remain on my spouse’s plan without being penalized when I do sign up? Should I delay signing up for Part A or should I sign up since I am not contributing? If I delay, can I be turned down for supplemental insurance later?
Hi Lisa – HSAs are not creditable coverage for Medicare. Additionally, once you enroll in Medicare, you can no longer contribute to an HSA. We would recommend signing up for Medicare as soon as possible to avoid the penalties. If you or your husband has worked and paid Medicare taxes for at least 40 quarters (ten years), you are eligible for premium-free Part A so it does not make much sense to delay signing up. If you enroll in Original Medicare (Parts A and B) during your Initial Enrollment Period and pick up a Medicare Supplement plan during your Medicare Supplement Open Enrollment Period, you will have your choice of Medigap plans and cannot face denial from the carrier.
Hello, my spouse/wife is disabled and I’m the working benefits carrier for a large employer (over 20 employees). My disabled spouse originally qualified for Medicare A & B however she filled out the yellow card waiving Part B with social security since she’s covered under my employees health plan.We are both in our 50’s.I have two questions : 1, If my spouse re applies for Part B will she be required to get a supplemental Medigap plan even though she’s covered by my employers insurance. 2, If she just keeps her Part A only will she be auto enrolled into Medicare when she turns 65?
Hi Scott – to answer your questions: 1) Your wife will not be required to get a supplemental Medicare plan; enrollment in these plans is always voluntary. 2) If your wife is collecting Social Security for at least four months by the time she turns 65, she will automatically enroll. Otherwise, she will need to enroll online, over the phone, or in-person with Social Security.
I am 66 and my spouse is 75. We are both still working and we are both on my employers health plan. My employer has only 13 employees. I have not yet enrolled in Medicare because i thought it was not a problem as I had health insurance through my employer. I am reading that this may be a problem because we are less than 20 employees.
Hi Sally-Anne – unfortunately, that is correct. We would recommend enrolling in Medicare as soon as possible; dropping your employer plan is a qualifying event for a Special Enrollment Period.
HI I’m enrolled in Medicare part A and B. I’m 69 and just started working at Delta airlines. Should I cancel their medical insurance since I have medicare?
Hi Maria – since you are working for a large company, your employer coverage would be creditable for Medicare Part B. You could pause your Part B coverage and enroll in the employer plan. It’s beneficial to keep Part A since it offers additional coverage, you can have it at the same time as you have your employer coverage, and you’ll have it premium-free if you or your spouse has paid Medicare taxes for at least 10 years while working.
What am I required to sign up for under the following situation. Turning 65 and not an employee BUT being paid as a result of an employment agreement that was triggered as a result of a change in control. In addition I am covered ( and pay for coverage) through that former employer as a result of post retirement medical benefits.
Hi Dave. Your best option is to compare both health plans side by side to see which one gives you the best benefits with the lowest premium. I would speak to your benefits administrator to confirm if the coverage is creditable under Medicare, otherwise, you will be penalized for delaying Part B and Part D.
Can an employer over 20 employees reimburse medicare supplement, Part D and part B premiums?
Hi Judd! Yes, your employer can reimburse the premiums for Medigap.. However, there are restrictions with Part B & Part D reimbursement from employers.
I have received SS disability since 2007 and have Medicare Part A. I have several rare and life threatening illnesses. My specialists don’t accept Medicare. I need at least 3-4 surgeries soon. BCBS is suddenly claiming I MUST get Medicare Part B, they have been already claiming that I have Medicare as my primary insurance since I turned 62 (even though I only have part A)! I still pay all my premiums to my company and am considered an active employee. I have had BCBS PPO through my employer from 1994 until 2021. I have a LTD benefit letter from my (former-they were purchased by a huge corporation) company saying I can keep my employer insurance benefits until I’m 65 (Medicare eligible). Now BCBS is coercing me to take Medicare part B saying they won’t pay my claims. I need help!
Hi Kathryn, we are sorry to hear about your health care situation. Unfortunately, Medicare Part A is only hospital insurance and will not cover your surgeries. If your previous company had fewer than 100 employees, it would be secondary to your Medicare if you had both while under 65.
I retired on a disability from the Post Office in 1986. I have had continuous medical coverage from OPM since 19659 until now, September 2021. I am 73 years old and today I enrolled in medicare part A. I was told that there would be a penalty for part B because I was not employed. Does my disability exempt me from employment along with the fact my health insurance was through my Post Office employment? I have form OMB 0938-07876 signed by OPM confirming continuous health coverage.
Hi Marsha. Unfortunately, FEHB is not considered creditable coverage under Medicare. The Part B penalty does apply if you did not enroll when you were first eligible. The only way to eliminate the penalties you incurred is if you qualify for a Medicare Savings Program due to being considered low-income.
It didn’t sound right to me that federal health insurance would not be credible. I googled a bit snd it said all FEHB is considered credible coverage. Did you misspeak or is there a rule you can refer to?
Hi Sarah. It’s only creditable under Part D, not Part B.
Hi there. I have been on Medicare since 2014, as a secondary coverage, since my wife’s plan through her employer has been primary. She is retiring at end of the year, and I am looking to get a Medigap plan soon in this year’s enrollment period. Will I need to complete underwriting info to be accepted? Thank kyou.
Hello! Once you no longer have coverage through your wife’s employer plan, you’ll be eligible for an 8-month Special Enrollment Period to enroll in a Medigap plan without having to go through medical underwriting.
Can you tell me why FEHB is not considered creditable coverage after we retired? We were originally told it was. Where can I find out my penalty for waiting 7 yrs.?
Hello – FEHB is creditable coverage for Medicare Part D prescription drug coverage, but not for Part B. For each 12-month period you go without enrolling in Part B, you will have a 10% surcharge.
Turning 65 in Dec 2021. Employer more than 20 employees Plan to continue working.
Contributing to HSA with high deductible insurance plan. Can I keep contributing up to my 65th birthday if I sign up for A in advance of birthday? I understand I cannot contribute after Part A benefits start but not clear on when to stop contributions. Read that if I sign up after turning 65, HSA contributions must be stopped 6 mos before. Thanks.
Hi Beth! If for any reason your Part A becomes retroactive, then you would want to make sure you stop contributing 6 months prior to your Part A effective date. If your Part A becomes effective the first of the month of your 65 birthday, then you would want to stop contributing the month prior.
I was told by an employee- who is 68 years old- that the company forces people to drop the company insurance and have only Medicare when they reach 65. How can they legally do that? And if it makes a difference this is in Louisiana.
I’m new to this company and in one year I will be 65. What can I do to fight against that when I turn 65?
Hello! This question is answered in the FAQ section of the article.
My husband is still working for a large employer and has health insurance thru them. He turned 65 July 3rd this year. He was unsure when he wanted to take retirement, so to play it safe, he decided to take and start paying for MC Part B. Does this mean that he will need to purchase a Medigap policy within the 6 months of taking Part B, or we will be penalized if he applies later? I know we probably messed up by taking B early, but with retirement dates so unsure, we thought we’d play it safe.
Thanks in advance for your help!
Hi Beverly! Your husband would need to enroll in a Medigap plan within 6-months after his Part B effective date in order to avoid medical underwriting. He can enroll any time outside this 6-month window, he will just have to answer health questions during the application process. He won’t have guaranteed issue after his Medigap Open Enrollment window has come and gone.
I deferred Medicare Part B when I first became eligible, since I had employer coverage and still employed. I will be retiring soon and applying for Part B, with the supplemental CMS L564. How long does it normally take to receive my Medicare Part B card. I work for the state of California, and the state’s Retirement healthcare manager is requiring a copy of it, to update my Medicare status. I’m anxious over a gap in coverage, since I have maintenance meds.
Hi Joy! It usually takes about 30 days to process your application, but it can take up to 90 days. You can keep an eye on the status of your application through your Medicare online dashboard.
Hello – I turn 65 in September and applied for Medicare Part A and B. My Medicare coverage starts on Sep 1. They also provided the Part B premium. I still work for a large company and have their insurance. Should I terminate the Part B until I am ready to retire from the company?
Hi Krish! Yes, you can delay Part B without penalty as long as your employer has more than 20 employees.
Hi, I am turning 65 in Sept and am presently working at Walmart with Blue Cross Blue Shield. Is it in my best interest to delay Part B until I retire from work? Or should I get the coverage to cover any gaps in medical costs? I am presently healthy with no medications or issues.
Hi Kathy! This would really be a question for your benefits administrator since employer coverage varies from employer to employer. They will be able to give you a better idea of how they work together and which option will give you the best coverage.
Hello-my spouse is turning 65 soon and is on my employer coverage (over 20 employees) and we have an hsa plan with family deductible of 3,200 and oop max of 5,000/12,500. My question is if he only keeps part A on medicare and dosen’t pay into part B what would his Medicare part A meet if he had an Inpatient stay at a hospital? Would he still have to meet his family deductible(it’s an aggregate plan) and his individual oop before Medicare part A pays? I know Medicare part A would not cover any outpatient costs.
Part A comes with an annual deductible, once that deductible is met then Part A would cover the costs of inpatient care. You would have to talk to your benefits administrator to determine if that deductible would count towards your family deductible.
My husband is turning 65 and his employer is saying he has to enroll in Medicare and they will pay for parts B C and D, I on the other hand am only 59 and will be left with no insurance, they have more than 20 employees, what’s our best option.
Hi Tina! As long as the employer has more than 20 employees, the insurance is creditable. If your husbands’ employer s saying he has to enroll in Medicare, it’s probably because they no longer want to pay the current premiums they are paying for you both. It sounds like they are trying to get him in a Medicare Advantage plan, which is not the best supplemental coverage. It’s cheaper than the alternative, which is why they are probably suggesting that. If they are going to refund the premium amount to him, then he should enroll in a Medigap plan. Unfortunately, if your husband does leave the group insurance and goes to Medicare, you will have to enroll in your own health insurance plan since you’re not eligible for Medicare yet. The Marketplace may be a good option for you.
My mother is turning 65. She is living outside the states, in Taiwan with National Health Insurance there. She has 28 work credits and thus not qualified for any discount on Medicare, does not receive any social security benefits. The house under her name in Kentucky is rented out as rental property and she receives rental income at right around the QMB limits, below the QMB limits after various deductions. I live in California and claimed her as dependent in tax year 2019 and 2020. She has no current plans of returning to live in the states but it could happen in the future.
I remember seeing somewhere that UK’s NHS could be considered creditable health coverage (not sure if this is correct) and thus was wondering is the National Health Insurance in Taiwan considered creditable coverage to allow for penalty-free enrollment if/when she returns to the states permanently?
If not, what are our options? If we need to go through QMB, do we apply for that with state of Kentucky or California?
Any advice you have would be highly appreciated.
Hi Wade! I do not believe Taiwan has an agreement with the United States regarding health insurance. I have not been able to find any information regarding this though on CMS. I would call Medicare directly to find out, but if I were to guess I would say it’s not considered creditable coverage. Your best option is to enroll her in Medicare when she is first eligible if there’s any chance she would be moving back to the states. Otherwise, she will have a significant penalty added to the standard monthly premium if she enrolls later. If she qualifies for QMB, they will pay her premiums for both Part A & Part B. You would apply for QMB in the state she will reside in. Her rental property will count as income but does not determine where she enrolls in QMB. If you think she may qualify for QMB, I would reach out to your local Medicaid office to see if they will pay any penalties she incurs due to delaying her enrollment since QMB is managed by the states Medicaid office. That may help you determine if she should enroll now or delay until, if, and when, she moves back to the states.
My husband will be 65 soon and intends to continue working where there are less than 20 employees. His weekly health insurance paycheck deduction is around $70.00. From what l understand it is suggested to enroll in Part A and B. Why would he want to pay part b plus employers insurance? Can he drop his insurance through his job? Would this be a qualifying event, or would he have to drop them during open enrollment?
Hi Tammy! Since his employer insurance is not creditable coverage, your husband would want to enroll in Part A & Part B during his open enrollment and drop his employer coverage. He would then decide between a Medicare Advantage or Medigap plan with Part D for prescription coverage. He could delay enrolling in Part B, but he will be penalized since his current employer has less than 20 employees.
He may still need to remain covered by his employers plan so that his wife is covered.
I enrolled in Part A Medicare when I turned 65 but I was still working with a large employer (over 2000 employees) and declined to enroll in Part B as I was covered under the employer health plan. I retired in July of 2021 at age 66 and was told I had the option to stay enrolled in my health care plan via COBRA for 18 months. I opted to do this in lieu of enrolling in Part B as I was informed my COBRA plan would pay as primary. I have now learned that (a) I was required to enroll in Part B even though the premiums were higher than my COBRA plan with United Health Care; (b) that my COBRA plan is not considered credible coverage according to Medicare; (c) that because I didn’t enroll within 8 months of leaving my employment I will now have to wait until Jan. 2022 to enroll and I will not have to pay a penalty for every month I did not enrole….17 or 18 months of penalty, $14.46 per every month I failed to enroll for the rest of my life. This is in addition to the cost of Medicare, who also goes back 2 years to determine your premium. What is the purpose of basing a premium on wages in the retirees past; when you retire your income is significantly less than it was 2 years prior. This is a travesty! Why isn’t this information made clear and transparent? The websites from my employer, Medicare and other websites linked to Medicare and COBRA have conflicting information making it even more confusing.
Hi Norma! It is correct that COBRA is not creditable coverage. With COBRA, you MUST enroll in Part B within the first eight months you have it. Even if your COBRA stays active longer than eight months. We have a great article that explains how COBRA and Medicare work together.
I have had my employer’s group health coverage since 1990 up to the present day. I retired from the company in the spring 2009 but was granted inclusion in the company health coverage until 2025.
The company was recently sold and the new owners are unwilling to continue this arrangement. I had creditable coverage uninterrupted for this entire period including Medicare Part A but not part B.
I am in the process of rearranging my health coverage and have found some big problems. I was told by Social Security when I applied for the required part B. that I must pay a penalty based on the time I did not have part B. Keep in mind creditable coverage is still in effect. The penalty amounts to just under two thousand dollars per year every year until I pass. I was unware of this egregious situation, and have received confusing and conflicting information from various sources in my quest for a resolution.
Please tell me there is no penalty due and why, as it seems to be the case as I read some of your writings.
Hi Jim! As long as the company has more than 20 employees, it should be considered creditable. You just need to have your previous employer benefits administrator complete the CMS-L564 form to present to Social Security to show proof that you had creditable coverage the entire time.
Thanks for getting back to me so promptly, much appreciated.
This is an ongoing head ache because CMS L564 was filled out and filed with the part B application and still I am told I have the penalty obligation going forward. Could it be that SS is reading line 5 of this form in appropriately? I worked for the company from 04-1990 through 04-2009 but my insurance was continued through to the present.
I certainly hope this is the case or something similar is in error, the penalty is egregious and I believe totally unwarranted.
Have you any other suggestions for this problem?
Hi Jim! I would contact your previous employer’s benefits administrator to confirm that the coverage was creditable. It’s not likely that SS is reading the form incorrectly. If the benefits administrator disagrees with what SS is saying, I would do a 3-way call with you, the benefits administrator, and SS to get it straightened out. Otherwise, it will be a back and forth battle.
One last question, does work after my retirement date have anything to do with this penalty problem?
Conversations early on with SS make me wonder, but my memory is a bit vague so I thought I’d ask.
The form CMS L564 is a bit vague about employment dates. That is what lead me to ask about line 5. Those that I have spoken with about this problem say no, but I’m still wondering.
Hi Jim! Your retirement dates COULD have something to do with it. Your employer coverage may have been creditable when you were still working, but once you retired that retirement plan that you stayed on may have not been considered creditable coverage. Your previous benefits administrator should know the answer to this for sure.
My wife is covered as a dependent on my employers health plan. I am not yet 65, but she will turn 65 this year. Do all the rules, stipulations, etc regarding Medicare vs. employer health plans apply to a dependent the same as the employee?
Hello! Yes, the rules & stipulations will be the same. Your wife should still enroll in Part A since it’s premium-free. She can choose to decline Part B without penalty as long as your employer group coverage is creditable. (over 20 employees)
I work for a company of well over 20 employees and my wife is covered on my group insurance. We contribute to an HSA and would like to continue since the benefits of that outweigh the cost difference between group insurance and Medicare. My wife turns 65 this year and I would like to delay enrollment in any form of Medicare for her since that would prohibit full HSA contributions. This should be OK as long as the group plan is creditable correct? Thanks.
Hi Kim! As long as your wife is NOT the one contributing to the HSA, you can continue to contribute to the HSA. This rule only impacts those on Medicare who are the ones contributing to their HSA. However, if she is the one contributing to the HSA, then yes she can delay enrolling without penalty as long as the group coverage is creditable.
My husband has prescription insurance through employer(20+ employees). My daughter has both this and Medicaid she is disabled she was signed up for a Medicare part d. I am worried his employer will drop all of us from script coverage, because she had part d. But if she drops part d her Medicaid says they won’t pay for her copays.
Hi Jen! It sounds like your daughter does not need to have coverage through your husband’s employer group plan for prescription medications if she already has both Part D and Medicaid. Since Medicaid picks up the copays, she should not have any out of pocket costs for her prescriptions. I would just double-check that her Part D plan includes her medications in their drug formulary. If all checks out, I would speak to your benefits administrator to see if they have any objections to your daughter leaving that plan, leaving her enrolled in just Medicaid and Medicare.
I retired from the federal government 14 years ago and did not take Part B because I continued to keep the same insurance by Federal Employee Health Insurance through BCBS. Does this qualify as employer health insurance to avoid the 10% per year penalty if I decide to enroll in Part B? Thank you for your help!
Hi Charles! Yes, FEHB is considered creditable coverage. You will not be penalized for delaying Part B.
I turn 65 in December. If I opt to keep employer coverage and add Part A & B (company is larger than 20 employees), will I be penalized later if I don’t sign up for a Medigap plan until I end my employer coverage?
Hi Jim! Most beneficiaries who have employer group coverage at a company with more than 20 employees delay enrolling in Part B since it’s considered creditable coverage. Medigap does not come with penalties, only Part B and Part D. What you have to watch out for with Medigap is your Open Enrollment Period. Your one-time 6-month OEP is triggered by your Part B effective date. This is the time when you can enroll without any health questions. So, if you’re delaying Part B for now, then your OEP for Medigap will also be delayed. You will not be penalized.
My Husband and I constantly are plagued by robo/solicitation calls about our insurance. If I call your number above, is that going to flip a switch somewhere in computer or phone land that will increase the prior mentioned calls? Please advise. Thank you.
Hi Noreen! I completely understand your concern. You don’t have to worry about that with us, we do not sell your information. If you give us a call, you’ll be connected with one of our licensed in house agents that will be happy to help answer any of your questions.
Hello, we are are small nonprofit with three full time employees. We pay for 50 percent of the medical benefits. One of our employees is on Medicare. Our insurance broker does not offer a 105 plan. The employee will pay directly for Medicare part b and d as well as a supplemental plan. Can we reimburse her for 50 percent of the medical cost through payroll? If so, is it taxable? This employee is not HCE. Looking forward to your answer.
Hi Cheryl! Unfortunately, without a Section 105 Plan set up, you won’t be able to reimburse your employee for any medical costs that are taxable.
I recently turned 65 and was advised by my company’s health insurance, CIGNA, that the prescription coverage in our plan was non creditable and I should enroll in Medicare Part D, which I did. I selected a mail order plan as my out of pocket cost was $0 for all my prescriptions. However, when the first prescription was ordered, my Part D insurer would not pay as Medicare shows I have other coverage. Medicare tells me the prescription must first be filed with my employer’s CIGNA plan. Since the prescription is sent directly to my Medicare Part D provider who fills the prescription and files the claim, how can it be sent through my CIGNA plan first?
Hi Donald! If you enrolled in your Cigna Part D plan through us, give our Client Care Team a call and they can help. If not, you’ll have to contact Cigna directly to get this issue resolved.
Hi Ron! As long as the employer has more than 20 employees, then the coverage is considered creditable under Medicare. You’ll get a Special Enrollment Period when you drop employer coverage. This allows you to enroll in Part B without being penalized for not doing so when you were first eligible. You will need to enroll in Part B before you get supplemental coverage, including Medicare Advantage. Make sure to compare the pros and cons of Medicare Advantage plans before enrolling in a plan. If you want prescription drug coverage with your Advantage plan, look into enrolling in an MAPD. If you’re looking for more comprehensive coverage with less out of pocket costs, then I would recommend enrolling in a Medigap plan and Part D plan.
I am 66, still working but I may retire in two years, Is there a particular document I should I submit to Medicare letting them know that my employer ( the State of New York) has covered my health insurance and that is why I have delayed the part B???
Hi Victor! Yes, you’ll need your employer to complete the CMS L564 form for you to submit to Medicare.
Can a member drop Part B, cancel Medicare plans eg. Med Supp and Rx plans and return to group health? If so, will there be any penalties to return to Medicare in the future when retiring or will this be an eligible SEP?
Hi Gillian, thank you for your question! This depends on the size of your employer. If your employer is considered a large employer with over 20 employees, then yes, you can drop Medicare without being penalized. You’ll get a SEP to enroll when you leave your employer coverage and retire. However, if your employer has less than 20 employees, you would need to contact your benefits administrator to find out if the coverage is considered creditable.
IF A PERSON IS ON A RETIREMENT PLAN FROM THEIR OLD EMPLOYER, CAN THEY LEAVE THAT RETIRMEENT PLAN AT ANYT TIME & HAVE A SPECIAL ELECTION TO DO WHATEVER THEY WANT? THEY ALREADY HAVE HAD Part A & b, tHANK YOU.
Hi Floyd! You would have to contact support from your retirement plan to confirm it’s considered “creditable coverage.” If the answer is yes, then yes, you’ll have a Special Election Period.