If you're turning 65 and continue working for an employer with fewer than 20 employees, you generally must enroll in Medicare Part A and Part B when you're first eligible. Many people mistakenly believe they can delay Medicare because they have employer health insurance. While that's often true for employees of large employers, it usually is not true for small employers.

 

Why?

Under Medicare's coordination of benefits rules, Medicare becomes the primary payer, and your employer group health plan becomes the secondary payer. The employer plan generally expects Medicare to pay first.

 

If you don't enroll in Medicare when you're required to, your employer health plan may still process your claims as though Medicare had already paid its portion. Since Medicare won't pay because you're not enrolled, you could become responsible for the amount Medicare would have paid. Depending on the medical services you receive, this can leave you with substantial unexpected medical bills.

 

Example

Imagine you're hospitalized in December and the total hospital bill is $20,000.

 

If you're enrolled in Medicare:

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• Medicare pays first.

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• Your employer group health plan pays second.

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• Your out-of-pocket costs are generally limited to your normal deductibles, copayments, and coinsurance.

 

 

If you aren't enrolled in Medicare:

 

• Medicare pays nothing because you never enrolled.

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• Your employer health plan may reduce its payment as though Medicare had already paid.

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• You could be responsible for thousands of dollars that Medicare would otherwise have covered.​

 

Before delaying Medicare because you have employer health insurance, verify whether your employer has fewer than 20 employees. Making the wrong decision can lead to late enrollment penalties and significant gaps in coverage. If you are unsure of how the rules apply to your situation, call us at 262-261-8027 and we can walk you through it. 

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