Does my company insurance work with Medicare?

Dear Toni: I am 67 and have group health insurance through my employer with a high deductible. My question is, should I have also enrolled in Medicare, even though I am still working? If so, who pays my claims first? I have talked with friends, my company’s HR department, their insurance agent and cannot get a straight answer. — Rhonda, Dallas

Dear Rhonda: Most answers about enrolling in Medicare can be found in the “Medicare & You” handbook.

Some people do not take Part B during their initial enrollment period when turning 65, because they have insurance through a current employer. The 2024 handbook, under the section “Should I Get Part B,” states: “It might be to your advantage to delay Part B enrollment while you still have health coverage based on you or your spouse’s current employment.”

When there’s more than one payer, the coordination of benefits rule decides who pays first. The primary payer pays what it owes on your first bill, then sends the rest to the secondary payer. You are still responsible for your deductible, whether it is Medicare’s deductible or your company insurance deductible.

How your coverage works with Medicare depends primarily on how many employees are on your employer group health plan. To summarize:

1. If your employer has 20 or more employees, your group health plan will generally be the primary payer. Enrollment in Part B is optional. If Medicare is a secondary payer and if you see a provider outside your employer’s insurance network, it is likely that neither the company plan nor Medicare will pay. (The employer must offer its employees 65 and older the same health benefits, under the same conditions, that it offers employees under 65.)

2. If your employer has fewer than 20 employees, Medicare pays first. Always check with your human resources department or group health insurance agent to confirm whether it is necessary to enroll in Medicare Parts A or B.

Remember that the six-month Medigap/supplement enrollment period begins when one first enrolls in Part B.

When you leave your employer group health plan, you can enroll in Medicare Part B under a special enrollment period. When enrolling in Part B past age 65 in this scenario, fill out CMS form L-564, “Request for Employment Information,” to avoid a Part B penalty.

Employees should visit Social Security as soon as possible to enroll in Medicare when their work status changes from full-time to part-time employee, when they decide to retire or are terminated and enrolled in COBRA. Employees will not qualify for special enrollment if they have COBRA or retiree insurance and wait too long.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.