How Does Medicare Work With Employer Coverage?

September 16, 2025

How Does Medicare Work With Employer Coverage?

Are you confused at to how employer coverage and Medicare work together? Call Lons Insurance we have the answers to all of you questions. Skilled, Reliable and ready to assist.

Understanding how employer coverage and Medicare work together.

Employer size:

Employers with 20 or more employees: If your employer has 20 or more employees, their group health plan will pay first for Medicare-covered services for the first 30 months after you become eligible for Medicare (Part A and Part B). After that, Medicare becomes the primary payer.
Employers with fewer than 20 employees: In this case, Medicare pays first, and your employer's plan might pay for some remaining costs depending on the specific plan details. This applies even if you're part of a multi-employer or multiple employer group health plan where at least one employer has 20+ employees.

2. Type of coverage:

Original Medicare (Parts A & B): The above rules apply directly to Original Medicare.
Medicare Advantage plans: If you have a Medicare Advantage plan, it usually replaces Original Medicare, so your employer's plan wouldn't interact with it directly. However, depending on the plan, it might offer additional benefits or cover expenses not included in your Medicare Advantage coverage.

3. Your situation:

Retiring before 65: If you retire before 65 and lose employer coverage, you'll need to enroll in Medicare to avoid penalties.
Disability: If you become disabled before 65, you may qualify for Medicare earlier, regardless of your employer's coverage.

Important things to remember:

Coordination of benefits: It's crucial to understand how your employer's plan coordinates with Medicare to avoid gaps in coverage or unexpected bills. Contact your employer's benefits administrator or Medicare for clarification.
Open enrollment: Enroll in Medicare during your Initial Enrollment Period to avoid penalties.
Medigap supplement plans: These plans can help cover out-of-pocket costs associated with Medicare.
Resources: Consult the Medicare website, Social Security Administration, or a qualified insurance agent for personalized guidance:
https://www.medicare.gov/
https://www.ssa.gov/
For additional questions Click Here and a licensed experienced agent will be in contact.

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