Senior Listening

Aging Services Specialist Many adults choose to work past age 65 — or are covered by a spouse’s employer insurance — which raises important questions about how Medicare works alongside group health plans. The good news is you have options and understanding them can help you avoid gaps in coverage or costly late penalties.

If you’re still working and have health coverage through your job or your spouse’s job, you may be able to delay Medicare Part B and Part D without penalty. The key factors are employer size and whether the group health plan is considered creditable coverage.

Employer Size Matters

The number of employees at your or your spouse’s workplace plays a big role in how Medicare coordinates with that insurance:

• 20 or more employees: The group plan pays first, and Medicare is secondary. You can delay enrolling in Medicare Part B and Part D without penalty, as long as you remain covered.

• Fewer than 20 employees: Medicare becomes your primary insurance. You (or your spouse) should enroll in Medicare Parts A and B when first eligible to avoid coverage gaps and late penalties.

Covered Through Your Spouse’s Job?

If you’re 65 or older and covered under your spouse’s employer insurance, the same rules apply based on the employer’s size. You can usually delay Medicare Part B without a penalty, as long as the employer plan is considered primary and creditable. However, once your spouse retires or loses that coverage, you must enroll in Medicare during the Special Enrollment Period (within eight months) to avoid a late enrollment penalty. It’s also wise to compare coverage — sometimes Medicare offers better benefits or lower outof- pocket costs.

What About Medicare Part A?

Most people get Part A premium-free. If you’re eligible, enrolling in Part A while still working or on a spouse’s plan can help with hospital-related expenses. But don’t enroll in Part A if you want to keep contributing to a Health Savings Account, as Medicare enrollment disqualifies you from HSA contributions.

When Employer Coverage Ends If your (or your spouse’s) group health coverage ends, you’ll enter a Special Enrollment Period and have up to 8 months to enroll in Part B without a penalty. This is a great time to consider adding prescription drug coverage (Part D) or supplemental insurance.

The time of transition from employer coverage to Medicare can be challenging to navigate. It is also a time when fraud can occur as a beneficiary is shopping for coverage.

Need Help?

Medicare decisions can be complex, especially when employer coverage or a spouse’s plan is involved. SHIP counselors and Senior Medicare Patrol are located at Area Agencies on Aging across Montana to assist with Medicare questions and concerns. If you think you have experienced potential Medicare fraud, errors, or abuse contact your local Senior Medicare Patrol. Call us at 1-800-551-3191.