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). 

Important Compliance Requirements: Groups with Medicare-Eligible Employees
If your group clients have employees or dependents approaching or over the age of 65 or are eligible for Medicare due to a disability, it is important to note the following group size guidelines for Medicare enrollment.

• 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.
   
• 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, and they MUST enroll in Medicare.

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.