If I have Employer Group Health Coverage
do I need to enroll in Parts A Hospital  & B Doctor Visits?

If you didn’t enroll when you were first eligible, the size of the employer determines whether you have to pay a penalty if you enroll later.

 Fewer than 20 employees.

.

You should sign up for Part A and Part B when you’re first eligible.   Medicare will be primary and pays before your other coverage.

Note

If you don’t enroll in Part B  when you’re first eligible, you may have to pay a Part B late enrollment penalty, and you may have a gap in coverage if you decide you want Part B later.

There may also be Part A penalties  if you don’t qualify for Premium Free Part A along with having to wait (Special Enrollment Periods) !

 

20 or more employees.

Ask your benefits manager whether you have group health plan coverage (as defined by the IRS). People with group health coverage based on current employment may be able to delay Part A and Part B and won’t have to pay a lifetime late enrollment penalty if they enroll later.

How you delay your coverage depends on your situation:

  • If you’ll be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you’ll automatically get Part A and Part B. You’ll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday. If you don’t want Part B, follow the instructions that came with the card. If you keep the card, you keep Part B and will pay Part B premiums.
  • If you won’t be getting benefits from Social Security or the Railroad Retirement Board (RRB) at least 4 months before you turn 65, you don’t need to do anything when you turn 65.

Here’s the form to fill out to get a special enrollment period, when you retire.

Enrollment Dates

If you’re eligible for premium-free Part A, you can enroll in Part A at any time after you’re first eligible for Medicare. Your Part A coverage will go back (retroactively) 6 months from when you sign up (but no earlier than the first month you are eligible for Medicare).

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, you may have to pay a penalty.

Note

Premium-free Part A coverage:

  • Begins 6 months back from the date you apply for Medicare (or Social Security/RRB benefits). To avoid a tax penalty, you should stop contributing to your Health Savings Account (HSA) at least 6 months before you apply for Medicare.
  • Begins no earlier than the first month you were eligible for Medicare.

 

Part A late enrollment penalty

If you aren’t eligible for premium-free Part A, and you don’t buy it when you’re first eligible, your monthly premium may go up 10%. You’ll have to pay the higher premium for twice the number of years you could have had Part A, but didn’t sign up.

Example

If you were eligible for Part A and have to pay a premium  for 2 years but didn’t sign up, you’ll have to pay the higher premium for 4 years. Usually, you don’t have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a special enrollment period.

 

 
 Medicare.gov I have employer Coverage
 

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you’re covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • You or your spouse (or family member if you’re disabled) is working.
  • You’re covered by a group health plan through the employer or union based on that work.

You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):

  • The month after the employment ends
  • The month after group health plan insurance based on current employment ends

Usually, you don’t pay a late enrollment penalty if you sign up during a SEP.

Note

COBRA and retiree health plans aren’t considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn’t apply to people who are eligible for Medicare based on having End-Stage Renal Disease (ESRD).

Note
 

If you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on your or your spouse’s current employment, you may be eligible for an SEP. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).

You may also qualify for a Special Enrollment Period for Part A and Part B if you’re a volunteer, serving in a foreign country.

Get an estimate of your Medicare eligibility date.

Learn how to sign up for Medicare if you have coverage through the Health Insurance Marketplace.Copied from Medicare.Gov

 

Should I get Parts A & B?
 

Most people should enroll in Medicare Part A (Hospital Insurance) when they're first eligible, but certain people may choose to delay Medicare Part B (Medical Insurance). In most cases, it depends on the type of health coverage you may have. Select the situation that applies to you to learn more. 

You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).

I'm currently working, and I have coverage through my job.

I have coverage through my spouse who is currently working.

I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.

I have TRICARE, and I'm a retired service member.

I have TRICARE, and I'm an active-duty service member.

I have CHAMPVA.

I have End-Stage Renal Disease (ESRD).

I have Marketplace Covered CA  or other private insurance.

I don't have any of these.

When, Why and How should you sign up for Part B - Dr Visits

20 comments on “Can you postpone Part A enrollment if you are covered under a Employer Group Plan?

  1. Are Medigap policies written during the 8-month Special Enrollment Period issued subject to the same terms as terms, with regard to pre-existing conditions, as those written during the Initial Enrollment Period?

        • When did you turn 65? Do you have a 1095 B or C form? That shows you had coverage, to avoid ACA/Obamacare mandate penalty.

          Here’s what the FEHB says:

          What Happens If I Don’t Take Part B as Soon as I’m Eligible?

          If you do not enroll in Medicare Part B during your initial enrollment period, you must wait for the general enrollment period (January 1- March 31 of each year) to enroll, and Part B coverage will begin the following July 1 of that year. If you wait 12 months or more, after first becoming eligible, your Part B premium will go up 10 percent for each 12 months that you could have had Part B but didn’t take it. You will pay the extra 10 percent for as long as you have Part B.

          If you didn’t take Part B at age 65 because you were covered under FEHB as an active employee (or you were covered under your spouse’s group health insurance plan and he/she was an active employee), you may sign up for Part B (generally without an increased premium) within 8 months from the time you or your spouse stop working or are no longer covered by the group plan. You also can sign up at any time while you are covered by the group plan. https://www.opm.gov/healthcare-insurance/healthcare/medicare/medicare-part-b-coverage/

  2. Thank you for responding to my question on Sept. 25th

    I still don’t see an answer to my question as to whether the parent must be currently working or if having group insurance as a retiree from the parent’s former employer provides the same protection to not incurring a penalty.

    This is a wonderful service you’re providing and I will be sure to refer my friends to you for their insurance needs.

  3. I’m disabled and covered under my Dad’s retirement plan. I just qualified for Medicare. Must I enroll in Part B or can that be postponed as I have employer coverage?

  4. I turned 65 a few months ago, I’m still working and I’ve stayed on my employers group plan.

    1. If I cancel my current medical insurance, with my employer, then I guess I would need to sign up for Medicare part “B”, right?

    2. My income probably falls into the first tier so there would be a premium of $134 +/-

    3. Then I would need a Medicare Supplemental plan like my High Deductible F so another premium of $75 or so, right?

    4. Then another supplemental Prescription Plan Part D with a premium of around $40

    5. Also, my Granddaughter, whom I have legal custody of is on my group plan, so I would need to get individual coverage for her, right?

    6. I believe that was around $350 for a plan I liked.

    7. So I would end up with an estimated monthly expense of:

    Part B Medicare $134
    Plan Hi F Medi Gap $75
    Part D Rx $40

    Individual Plan for Grand daughter

    $350

    For a total of $599

    8. On Medicare Part “B” how would she pay that premium?

    A. Monthly bank withdrawal?

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