KBenefits Insurance Services
Medicare & Employees

Medicare & Employees

Six months before turning 65, employees should start thinking about their medicare plan options.  Begin to learn about the differences between plans, medicare supplement vs medicare advantage plans (MAPD's). 


* If you work for a Small Employer (under 20 employees), then you must sign up for Medicare A & B. 

* If you work for an Employer with 20 or more employees, then you can decide if you wish to stay on your Employers health plan or you can consider moving to a Medicare Supplement with Part D prescription (or) a Medicare Advantage health plan.


Company Size:

  • If you have groups with less than 20 employees: Any Medicare-eligible employee (or spouse/dependent) MUST enroll in Medicare, because by law Medicare becomes their primary coverage.  If the individual does not enroll into Medicare when first eligible, claims may not be paid, and they may face financial penalties due to late enrollment.
  • If you have 20 or more employees:  If an employee is currently working and coverage is through a credible employer plan, the employee (or spouse) may be able to delay Part A and Part B.
  • If you have groups with less than 100 employees: If an employee (or spouse/dependent) qualifies for Medicare due to a disability, Medicare would be considered their primary coverage.
  • All Employers:  Part D Prescription - Creditable Coverage - If the prescription drug plan is not considered creditable coverage, Medicare-eligible employees may face a financial penalty after retirement.

Sample Letter: 
Prescription Creditable Coverage letter to be shared with employees.

Letter: Rx Creditable Coverage
Adobe Acrobat document [105.7 KB]
Creditible Coverage Letter - (customizable)
Letter - Creditible Rx Coverage.doc
Microsoft Word document [34.5 KB]

Important information about claim payments when eligible for Medicare.
When Medicare is the primary coverage, the plan reduces claim payments. Once a member is eligible for Medicare Part B coverage, the amount Medicare would have paid as the primary payer for covered services is calculated and the member’s benefits are reduced by this amount. This amount is not covered by the fully insured plan. Members not enrolled in Medicare Part B will be responsible for the costs that Medicare would have paid and, therefore, will incur a greater out-of-pocket expense.


Affected members will be responsible for the costs that Medicare would have paid and, therefore, will incur a greater out-of-pocket expense.  Affected members who wish to have Medicare Part B coverage before claim payments are reduced should enroll during the general enrollment period, which is January 1 through March 31.

Medicare is the primary payer when:
· Member is eligible for Medicare due to age and the member’s group size is 19 or fewer employees

KBenefits Insurance Services
Employee Benefits

Individual Health Insurance
Medicare Plan Options


Christopher S. Kudryk
Insurance Specialist

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

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