How Medicare and Employer Insurance Work Together

Medicare and employer insurance together; woman typing on laptop beside file with company health care

If you’re 65 or older and still working, you may be wondering how Medicare and employer insurance work together. It is possible to have Medicare and employer insurance at the same time, but you need to know a few specifics, like when to enroll in Medicare and who is the primary and secondary payer.

Medicare and employer insurance: primary vs. secondary payer

If you have Medicare and employer insurance at the same time, it’s very important to know who the primary payer is and who the secondary payer is. Knowing this could determine what doctor you see, what pharmacy you use, and what medical treatments are covered by your plan. Determining this is quite easy and depends on how many employees your company has. If your company has more than 20 employees, your employer insurance will be the primary payer. If it has fewer than 20 employees, Medicare will be the primary payer.

Note: if you age into Medicare and your company has fewer than 20 employees, they could provide you little to no coverage, so it may benefit you to go ahead and enroll in Medicare. If you work for a large company, however, you may decide to delay enrolling in Medicare Part B so you won’t have two premiums to pay every month.

When to enroll

Most people will automatically be enrolled in Medicare Part A, but unless you are already receiving Social Security benefits, you will need to enroll in Medicare Part B yourself. The best time to do this is during your Initial Enrollment Period (IEP). Your IEP is the three months leading up to your 65th birthday, your birthday month, and the following three months.

However, if you have employer insurance, you may qualify for a Special Enrollment Period (SEP). This allows you to enroll in Medicare Part B later and not incur a late enrollment penalty. Once your employer insurance ends, you have eight months to enroll in Medicare Part B. Enrolling after that window means you could be hit with a costly penalty that sticks with you the entire time you have Medicare.




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