It has become a common dilemma for people who are about to turn 65 years old and are still working- if they should enroll in Medicare, especially if they are covered by their employer’s health insurance plan. Although it may easy as yes or no, the answer to this is not as simple as it may seem.

One important factor that could determine whether you need to enroll in Medicare Part B is the size of the employer (company). If the company has 20 or more number of employees, then, the insurance is the primary coverage. As long as you are still employed for the company, neither you nor your spouse (if you have one) who is covered by the plan need to enroll in Medicare Part B. By the time you leave your job, the both of you (you and your spouse) may enroll in Part B on a special enrollment period, which often lasts for eight months after you stopped employment.

On the other hand, if there are more than 20 employees, then you should enroll in Medicare right away after you have been eligible as it will be the primary payer. For secondary payer, the plan of the employer will not be paying for the expenses covered by Medicare. If you have a spouse who is on the plan as well he/she can continue on the plan until the age of 65.

Other Questions- Answered!

What if my employer is the primary payer, should I enroll in Part B?

Unless you have a spouse who needs coverage, it would be useless to pay premiums for both plans. This is due to the complex formula that comes with Medicare, which is used in determining how much it will pay for the services as the secondary payer. The program does not necessarily fill in the gaps between the charges from the provider and what the employee is paying.

If I’m working for a small company, should I still keep my employer coverage?

You can ask the insurance company of your employer regarding the kind of gap coverage that is being offered as a secondary payer to Medicare. For smaller plans, there will be limited provider choices. But if your spouse needs coverage, then it would be a better idea to just buy a private Medigap plan.

In the case of corporate retiree benefits, they are often secondary to Medicare- even if you have never been enrolled in Medicare. It would be expected that retiree health plans will differ depending on the amount of gap coverage that is being provided. Therefore, it will be a good idea to just check with the benefits administrator. Also, you may be better off if you have a private Medigap plan. If you have a spouse who is younger than 65 years old and who is on the employer plan also, check whether the retiree health plan will be ongoing to provide 100% coverage. Hopefully this helps answer your Medicare eligibility while working, but if not, please contact me and I’ll go over your options.