Medicare rules for employer health plans, in one place.
Medicare touches an employer plan in three places: the Part D creditable coverage notices, employees and COBRA participants who become eligible, and retiree coverage. Start with the area that matches your question.
Three areas, and the page for each.
Part D Notices
The creditable coverage notice and the reporting that goes with it.
COBRA And Medicare
What changes when someone becomes eligible for Medicare.
Retiree Benefits
Coverage for retirees, before and after Medicare.
Notices, reporting and coordination.
Certificate Of Creditable Coverage
The Medicare Part D notice.
Reporting Creditable Coverage
The two Part D disclosures.
COBRA-To-Medicare Transitions
What happens when a qualified beneficiary becomes eligible.
Medicare Coordination Guidance
How group coverage and Medicare work together.
Medicare Maximization
Making the most of Medicare alongside the group plan.
Before and after Medicare.
Medicare And Retiree Benefits Guidance
An overview.
Group Retiree Medical Benefits
Designing retiree coverage.
Retiree Benefits Strategy
Planning the liability and the offer.
Pre-Medicare Retirees
Coverage before Medicare eligibility.
Medicare-Eligible Retirees
Coverage once retirees can enroll.
Retiree HRAs, Medicare HRAs And Spousal Incentives
Account-based options.
Retiree HRAs For Public Employers
Retiree HRAs in the public sector.
Medicare Secondary Payer Rules For Working Aged Employees
Disregard Medicare Entitlement
A group health plan may not take into account that an employee or spouse is entitled to Medicare based on age.
Same Benefits At 65 Plus
Employed individuals aged 65 or older, and employed spouses aged 65 or older, must receive the same benefits under the same conditions as those under 65.
The 20 Employee Threshold
These rules apply to plans of an employer with 20 or more employees on each working day in 20 or more calendar weeks in the current or preceding calendar year.
Smaller Employers Differ
For employers below the threshold, Medicare is generally the primary payer for working aged employees.
Separate Rule For ESRD
The statute has its own separate provisions for individuals with end stage renal disease, which should not be confused with the age based rule.
Review Eligibility Practices
We can help you with reviewing how your plan documents and enrollment practices treat employees who are 65 or older.
Source: 42 U.S.C. 1395y.
Common Questions About Medicare And Employer Plans
What is the Part D creditable coverage notice?
A notice that tells Medicare-eligible individuals whether the plan’s prescription drug coverage is expected to pay as much as standard Medicare Part D. See the certificate page. Employees nearing 65 can find their dates with our Medicare enrollment window calculator. To place the Part D notice and the CMS filing on your calendar, use our Part D deadline calculator.
When does it have to go out?
Before October 15 each year, the start of the Medicare annual enrollment period, and at certain other times such as when someone joins the plan. Our free Medicare Part B late enrollment penalty calculator estimates the cost of delaying Part B.
Is there a second disclosure?
Yes. The plan also reports to the Centers for Medicare and Medicaid Services. The reporting page explains both disclosures.
What happens when a COBRA participant becomes eligible for Medicare?
It can end or change their COBRA rights. The COBRA-to-Medicare page walks through the transitions.
Can an employer offer retirees coverage?
Yes, in several ways, including group retiree medical and retiree HRAs. The retiree pages compare them for coverage before and after Medicare.
Is this legal advice?
No. For a question specific to your company, involve your counsel. We can help you frame the question and bring the plan facts.
Ask us one we did not answer →
Related Reading: Supplemental Insurance for Employers.
Related guides.
Medicare Secondary Payer Rules
When your plan pays first and when Medicare does.
Medicare Enrollment and HSA Contributions
Why the HSA limit is zero once Medicare starts.
Older Workers and Benefits Guide
Age rules, Medicare timing and releases.
Retiree Health Benefits Guide
Promises, vesting and making changes.
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