Medicare With Employer Coverage

There are a number of rules to be aware of when it comes to applying for Medicare with employer coverage. It is important to understand the valid waivers for Medicare part B for individuals who are working at age 65 or older. We will review the rules, how to apply for delayed Medicare Part B and how to determine the best solution for you.

Not understanding the options can lead to costly life-long delayed enrollment penalties for both Part B and D of Medicare.

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Valid waivers for Medicare Part B

Let us start with the Part B waivers for those actively working at age 65 and older. These rules also apply to someone who has coverage through their actively working spouse. There are three criteria to consider when figuring out if you can waive Part B of Medicare without having a future penalty. Those not electing Part B need to meet all three in order to waive it without a future penalty.  If at any time they are not meeting any of the three, in most cases, they should apply for Part B.

· Employer size of twenty or more employees

· The first requirement to waive part B when you have Medicare with employer coverage is; the size of the employer. Those working for employers of twenty or more employees can waive B if they also meet the other 2 criteria.  Those working for employers of less than 20 employees should enroll in Medicare Part B. The reason for this is based on primary coverage. Medicare is primary for employer groups under twenty. As a result, Medicare Part B must be in place for those sixty-five and older for the secondary employer plan. Without part B they run the risk of the secondary employer plan refusing to pay the 80% that Medicare should have covered.

· Actively working

· The second requirement is actively working status. To have a valid waiver for Medicare Part B the person must be actively working. You can also waive part B if they are getting coverage through an actively working spouse. This is the most common mistake that occurs. Someone over the age of sixty-five is working and getting coverage through work. They then stop working but maintain employer coverage or elect Cobra.  They do not currently have Medicare Part B and see no need to sign up for it since they are continuing with coverage.  The reality is if they are no longer working, they must sign up for part B. If they do not, they could miss their Part B election opportunity and will have a delayed Part B enrollment penalty when the do finally get it.

· Having coverage through the working spouse’s employer

· The third requirement. The working spouse must be on coverage through the employer they are working for. Often is it assumed that if you are working at age 65 or older and have coverage, it does not matter where the coverage is from. The person is working but has coverage through their retired spouse. Maybe they have it through the health exchange or an old employer.. e bottom line is the only coverage that allows for Medicare part B to be waived is the coverage offered by the employer you are working for/with. The same applies for the spouse if they are getting coverage through the working person.

Important things to know

Here are common misconceptions when it comes to coverage that does not provide a valid reason to waive Medicare Part B.

· Cobra is not a valid waiver. You must be actively working to waive B and those on Cobra are not actively working. If you are working and getting coverage through Cobra, it still would not count because you are not obtaining coverage through the employer you are working for.

· VA coverage is not a valid waiver for Part B. Having VA drug coverage is a valid waiver for Medicare Part D, however.

· Coverage through an employer other than the one you actively work with is not a valid waiver

Medicare with employer coverage: Penalty

So, you did not have part B when you should have. Unfortunately, there will be a penalty once you do enroll. The penalty is based off every 12-month period you did not have Medicare part B when you should have. The penalty is 10% of the standard part B premium ($164.90 in 2023) per every 12 month period you didn’t have part B.  So, if you went 3 years without Medicare Part B, you would have a 30% monthly lifetime penalty when you do enroll.

Delayed part B enrollment process

There are two ways to enroll in Medicare Part B on a delayed basis.  The first is with loss of employment or loss of group coverage which creates an 8-month SEP to enroll. The application can be done online or at a local Social Security office. You will need both the employment verification form (CMS L564) and the Medicare Part B enrollment form (CMS 40B).  Both need to be completed prior to applying.

Delayed part B enrollment without a SEP

Those without a SEP to enroll in Part B will need to apply during the Part B GEP (General Enrollment Period) which runs from January 1 through March 31 every year.  The rule for GEP enrollments changes on 1-1-2023. As of that date, applications will be effective the first of the next month. They will no longer be delayed until July 1. Learn more about changes to Medicare for 2023

Medicare with employer coverage:  Tips

· The MA SEP election for a delayed B enrollment is prior to the part B effective date. You do not have 60 days after the effective date to put in an application. The 60 days after B effective election is for loss of employer coverage.

· Enrolling in Medicare Part B is not an SEP for a part D drug plan. Enrolling in Part A and loss of group coverage would be, however.

· HSA contributions are not allowed for anyone enrolled in Medicare Parts A or B

· With a delayed Part B enrollment, Part A of Medicare will retro up to 6 months back. For example, if someone turns 65 in June but applies for Medicare A and B in October, Part B will start November 1, but Part A will retro back to June 1 (first of the month you turned 65)

Open Enrollment Period is also a great reminder to review your Medicare Advantage plan each year so you can make sure you have the coverage you need going forward.

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