Medicare with Small Group Insurance
Medicare is a federal health insurance program for people age 65 and older, as well as people with certain disabilities and end-stage renal disease (ESRD). Small group insurance is health insurance that is offered by employers to their employees.
How Medicare works with small group insurance depends on the size of the employer group. If the employer has 20 or more employees, then the employer’s group health plan is primary and Medicare is secondary. This means that the employer’s plan will pay first for covered medical expenses, and Medicare will only pay for any remaining costs up to its limits.
If the employer has fewer than 20 employees, then Medicare is primary and the employer’s group health plan is secondary. This means that Medicare will pay first for covered medical expenses, and the employer’s plan will only pay for any remaining costs up to its limits.
If you have small group insurance and you are approaching Medicare eligibility, you should contact your employer’s benefits administrator to find out how Medicare will work with your group health plan. You should also contact Medicare to learn more about your options and to enroll in Medicare Part B if you have not already done so.
Here are some additional things to keep in mind about how Medicare works with small group insurance:
- If you have small group insurance and you enroll in Medicare Part B, you will need to pay a monthly premium. However, you may be able to get a premium reduction if you have employer coverage that is considered to be “creditable coverage.”
- If you have small group insurance and you delay enrolling in Medicare Part B, you may be subject to a late enrollment penalty. This penalty is equal to 10% of your monthly Part B premium for each year that you delayed enrollment.
- If you have small group insurance and you retire, you may be able to keep your employer coverage through COBRA. However, you will need to pay the full cost of your premiums.
If you have any questions about how Medicare works with small group insurance, you should contact your employer’s benefits administrator or Medicare.
