Welcome to the Centers for Medicare and Medicaid Services (CMS) Employer Partner page. Employers may have questions about their employees’ healthcare coverage changes as they age into, and continue to work beyond their eligibility for Medicare. The information below can help to highlight and address these questions. We have also provided resources to aid in your decisions regarding Medicare eligible employees.
Beneficiaries 65 and over, and still working
Not all Medicare beneficiaries need Medicare at the time they are eligible. If you have employees who are covered through a current employer plan and are eligible for Medicare, those employees may still need to make some vital Medicare enrollment decisions. It is crucial that they understand what those decisions are and when they should be made if eligible beneficiaries are still employed by you. It is important to understand how their current coverage works with Medicare when they become eligible for enrollment.
If your employees aren’t getting benefits from Social Security (socialsecurity.gov) TTY users should call 1-800-325-0778 or the Railroad Retirement Board rrb.gov, TTY users should call 1-312-751-4701) at least 4 months before they turn 65, they'll need to sign up with Social Security to get Parts A and B. However, depending on the size of the employer, they may be able to delay Parts A and B without having to pay a penalty if they enroll later. Learn more about whether you should get Parts A and B.
Enrolling with a Special Enrollment Period
People age 65 or older who don’t enroll in Medicare Part B when first eligible can enroll later, during the Special Enrollment Period, IF they or their spouse is currently working, and have coverage by an employer or union Group Health Plan (GHP) based on that employment. Those who have Medicare based on disability can enroll if they, their spouse, or their family member is working, and have coverage by an employer or union GHP (with at least 100 employees – also known as a Large GHP) based on that employment.
If eligible for an SEP, a person can sign up for Part B without a penalty:
- Anytime while he or she is covered by the employer or union group health plan based on current employment.
- For up to 8 months after the group health plan coverage or the employment ends, whichever happens first.
There are some important things to know about what is and isn’t considered Group Health Plan coverage:
- COBRA coverage and retiree health plans aren’t considered coverage based on current employment. Individuals who have COBRA and retiree coverage aren’t eligible for a SEP when this coverage ends.
- Plans that are unavailable to employees (e.g., a plan that only covers self-employed individuals) aren’t considered GHPs. Individuals with this type of coverage aren’t eligible for a SEP.
- Paying a stipend for someone to join the Marketplace or other private insurance isn’t considered Group Health Plan coverage, so people with this type of coverage aren’t eligible for a SEP.
- The Small Business Health Options Program (SHOP) in the Marketplace is Group Health Plan coverage, so people covered by a SHOP plan because of their or their spouse’s current work do have access to a SEP.
- These rules are different for people with End Stage Renal Disease (ESRD).
Beneficiaries who are over 65 or under 65 and have a disability
In most cases, employees don't need to do anything until they (or their spouse) retire or they lose the employer coverage. (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). Learn more about whether you should get Parts A and B and what happens when your employment or coverage ends.
Knowing who pays first
Medicare beneficiaries who still have employer benefits may be unsure about how their employer benefits work with their Medicare benefits. Questions regarding whether their employer-based insurance will pay first or second when deciding whether to enroll in Part B can be a concern when they are new to Medicare. If Medicare is primary to other insurance and a person isn’t enrolled in Part B, the other insurance may not pay all the uncovered costs. Below are some examples of how Medicare works with other insurance:
- If a person is eligible for Medicare due to ESRD, other insurance (from work or from other sources) is primary to Medicare for the first 30 months starting the first month the person is eligible for Medicare whether or not an application has been filed.
- If a person is eligible for Medicare due to age, insurance from current work is primary to Medicare if the employer has more than 20 employees.
- If a person is eligible for Medicare due to disability, insurance from current work is primary to Medicare if the employer has more than 100 employees
Contact us for questions about Medicare, benefits, how and when to apply call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. TTY users should call 1-877-486-2048
Click on the link for more information about the new Medicare "What's Covered App"!
For additional help, contact a local State Health Insurance Assistance Program (SHIP) to get free, personalized counseling on Medicare coverage, claims, appeals and help for people with limited income and resources. Call 1-800-MEDICARE or visit Medicare.gov/contacts or visit shiptacenter.org to get information or reaching your local SHIP.
To access a Medicare and You handbook electronically, https://www.medicare.gov/medicare-and-you
Care Compare Tools: https://www.medicare.gov/care-compare/
For more information, including publications and web resources for employees and retirees that are eligible for Medicare please visit /Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/Employer-community
**Please send any questions to Partnership@cms.hhs.gov