347 N. Pottstown Pike, Suite 200 | Exton, PA 19341

Roadmap to Medicare Over 20 Employees

Customized Roadmap Report

Click on the image to download your 1 page Roadmap

Enrolling in Medicare

After reviewing ALL of the information on this webpage, click on Enroll Later or Enroll Now for detailed enrollment/deferral instructions based on your situation.

If Group Health Plan is lower cost than Medicare, you have a choice:

Defer Medicare Part B and Enroll in Part A only (recommended)

Defer both Medicare A and B

If Medicare is lower cost than Group Health Plan, your enrollment instructions depend on your age.

I am younger than age 65 and 3 months

I am older than age 65 and 3 months

Your Roadmap is based on…

  • Your Primary Insured intends to remain ACTIVELY WORKING (at the employer providing your benefits)
  • You ARE covered under the Group Health Insurance Plan
  • The employer providing health insurance has MORE THAN 20 employees

Recommendation Summary

Since you have creditable coverage (group coverage based on current active employment), you are NOT required to enroll in Medicare at this time.  However, if you do not have a Health Savings Account, we recommend that you enroll in Medicare Part A and defer your Part B. 

If you do not enroll in Medicare A and/or B at this time, you will not accrue a penalty.  You will have a Special Enrollment Period (SEP) when your group coverage and/or your employment end to enroll in Medicare.  You will need to show proof of creditable coverage when you go to enroll later (it is not necessary at the time you defer).

Will I receive a penalty if I don’t enroll now?

No. You will not receive a late enrollment penalty provided you remain covered under the group creditable coverage and your primary insured remains actively at work at the employer that provides your benefits.

Part A: If you are eligible for Premium-Free Part A (you or your spouse has paid 40 quarters of Medicare taxes), you WILL NOT receive a Part A Penalty for enrolling after age 65.

  • Since Part A is Premium-Free for many people, they commonly enroll in Part A even if not necessary (special considerations apply if you have an HSA account).

Part B: You will receive a Part B Late Enrollment Penalty if you do not have creditable coverage after age 65.

  • Creditable coverage is group health insurance coverage while the Primary Insured is actively working for the employer providing the Group Health Plan.
    • Severance, COBRA and/or Retiree Plans are not creditable for avoiding the penalty.

A 10% penalty added for every 12 months you go without creditable coverage. Months need not be consecutive. See Details on how the penalty is calculated.

  • The penalty will be assessed on the Base Medicare Premium for as long as you are enrolled in Medicare.

Part D: You will receive a Part D Late Enrollment Penalty if you do not have creditable prescription coverage after age 65.

  • Creditable prescription coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

A 1% penalty added for every 1 month you go without creditable prescription coverage. Months need not be consecutive.

  • The penalty will be assessed on the Average Medicare Part D Premium for as long as you are enrolled in Medicare Part D.

Do I need Medicare to have full coverage?

No.  Your group coverage should remain primary insurance as long as the employment that it is based on continues. 

Medicare “Who Pays First” Law states that your Group Health Insurance will remain primary insurance at age 65 or older as long as you remain covered by Group Insurance based on Current Active Employment through an employer with more than 20 employees.

What is my deadline to enroll?

You can enroll anytime after age 65 up to 8 months after your group coverage or the employment that it is based on ends.

Part A: As long as you are eligible for “premium-free” ($0) Medicare Part A, you can sign up for no cost Part A (if you’re eligible) any time during or after your Initial Enrollment Period. Your coverage start date will depend on when you sign up.

  • If you have to pay a premium for Medicare Part A, you can only sign up during a valid enrollment period (see Part B enrollment periods below).

Part B-SEP: You will have an 8 month Special Enrollment Period from the time your group health coverage or the employment that it is based on ends (whichever comes first) to enroll under a Special Enrollment Period.

  • Severance, COBRA and/or Retiree Plans are not based on current employment. Your 8 month SEP starts the date your employment ends. If you have this type of coverage, you will not be eligible for a SEP when it ends if it is outside of 8 months.

Part B-GEP: If you miss your Initial Enrollment Period, you will be able to enroll annually during the General Enrollment Period (however, penalties may apply).

  • The General Enrollment Period is from January 1st to March 31st each year. Your Part B effective date will be the 1st of the month following your enrollment.

Secondary Insurance Options

Since your current plan will remain primary to Medicare as long as you remain enrolled in it, Medicare A and B is not required to have full coverage at this time. You will have the option to keep your Group Health Plan or switch to Medicare and elect a Medicare Supplement Insurance Plan or Medicare Advantage Plan and Medicare Prescription Drug Plan.

Does it make sense to drop my group health plan to enroll in Medicare?

A general rule of thumb is that if your group health plan costs on average less than $300/month/person or about $3600/year/person, then your group health plan is more cost effective than Medicare.

  • Please add up the premiums, copays, deductibles and coinsurances (everything except Rx cost) of your current group health plan for comparison.

However, if you think you may pay more than that, or you are seeking lower deductibles and copays, then you may want to explore Medicare further.

Please contact us for a Medicare Cost Analysis to help you better evaluate if your Group Health Plan or a Medicare plus a Private Medicare Supplement and Medicare Prescription plan is more cost effective.

  • If Medicare coverage is more cost effective than your current plan, you may want to replace your current plan.

Underwriting Considerations

Once you enroll in Medicare Part B, you will have an Open Enrollment Period/Special Election Period to choose your secondary coverage without having to medically qualify.

Additional Considerations

Spouse Under Age 65-  If your spouse relies on your group health plan for benefits, please be mindful that if you come off your group plan, your spouse will have to go on COBRA, seek benefits through their respective employer, or purchase individual health insurance until they become Medicare eligible.

Effective Date Considerations- Reminder, when you apply for Medicare at age 65, you cannot choose a specific effective date for the benefits (and premiums) to start.  The only way to influence the effective date is by which month you enroll online.  Please contact us ASAP if you are trying to achieve a specific start date that is something other than the first of the month of your 65th birthday (possibly to coordinate with your group plan ending).

Important HSA Considerations– You cannot continue to contribute to your Health Savings Account (HSA) once you enroll in Medicare Part A.  If you are enrolling in Medicare after age 65, your Part A effective date may be back dated up to 6 months.  Please contact us to discuss the HSA maximum contribution rate for you circumstances.  Click Here for Details and Rules.

  • This does not apply to Flexible Spending Accounts (FSA) or Health Reimbursement Accounts (HRA).  Medicare does not have any restrictions on these types of accounts.