If you are eligible for Medicare and still working, or if you have employer health insurance through your spouse, there are some rules you need to know.

If you are 65 and still working – and your employer has fewer than 20 employees, you must use your Medicare. Medicare must be your primary insurance and your (or your spouse’s) employer health plan can be secondary.

If your employer has more than 20 employees, your employer plan can be your primary insurance and you don’t need to take Medicare. But….. you should compare the employer plan to Medicare and see if you would be better off taking Medicare.

If you are under 65 and on Medicare due to disability, the rules are different.

If you are under 65 and eligible for Medicare because you are disabled, the employer (your spouse’s employer) must have more than 100 employees for you to stay on the group health plan. If the employer has fewer than 100 employees, you must take Medicare. Medicare must be your primary insurance.

When a person has been on Social Security Disability for 24 months, they automatically get Medicare.  If you are disabled and have employer coverage through your spouse, you need to pay attention to this rule.

Making a mistake will cost you if you have employer health insurance and Medicare.

If your employer is not aware that you have Medicare and you stay on the employer health plan when you do not conform to the rules, you can get into big trouble.

If your employer later discovers you should have used Medicare as your primary health insurance, you can be asked to pay back all premiums and payments that were provided through the employer plan for your health care.

The employer can kick you off the group plan, ask for you to pay back lots of money, and you will not get a “special enrollment period” to enroll in Medicare. You will have to wait for the Medicare “General Enrollment Period”, which is January through March each year. During that period, you can apply for Medicare Part B, but it will not begin until July 1st. On top of that, you will pay a late enrollment penalty for Part B for the time you had the employer health insurance you should not have had.

If you are over 65 and work for a small small employer, you must use Medicare, or get into big trouble.

If you are over 65 and break the rules for using Medicare vs using your employer health plan, you can be kicked out of the employer health plan and asked to pay back any money spent on your insurance premiums and health care costs. But you will get a “special enrollment period” to enroll into Medicare Part B. You won’t have to wait until the general enrollment period.

The 100-employee rule rule for people under 65 with Medicare was news to me.  I learned this and a few other things from a presentation by the Medicare Rights Center.


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