Medicare and Employer-Sponsored Health Insurance

When you turn 65 years old, you qualify for Medicare health insurance.

However, if you still work, you have options for choosing your health insurance. We recommend comparing your options before you select Medicare as your primary insurance.

Researching early lets you investigate the cost before you decide and help you avoid Medicare late enrollment penalties.

Can I Stay On My Employer's Plan?

Yes, if your employer still offers coverage, you can stay on that plan.

In some cases, Medicare permits delayed enrollment in Part A (hospitalization) and Part B (medical insurance) without a penalty. You must currently be working and want to stay on your employer-sponsored health insurance. Check with your employer because the size of the company can determine how insurance works.

If your employer has more than 20 employees, your group health insurance becomes primary, and Medicare is secondary. If you keep your employer-sponsored health insurance, Medicare can help cover any gaps in insurance.

Typically, Medicare Part A costs $0 per month, so there's no downside to enrolling. However, you may not need to enroll in Medicare Part B (medical insurance) until you lose your employer coverage.

However, if you work for a company with fewer than 20 employees, Medicare becomes your default insurance. Your employer plan is secondary to Medicare. When Medicare is your primary insurance, they will process your medical claims first. Any costs that Medicare does not cover can be forwarded to your group employer insurance.

Consequently, Medicare recommends you enroll in Medicare Part A and Part B as soon as you are eligible to avoid a late enrollment penalty.

When Do I Enroll?

Fortunately, Medicare automatically enrolls you on the first day of the month you turn 65 if you receive Social Security benefits or Railroad Retirement benefits.

You are also automatically enrolled if you receive disability for 24 months or receive disability due to ALS.

If neither of these applies to you, then you will sign up for Medicare online or in person.

Remember, if you have any other health insurance or you make a change to your insurance, you need to let Medicare know. You can notify them by calling Medicare's Coordination & Recovery Center at 1-888-798-2627. TTY users call 1-955-797-2627.

Help with Medicare Costs, Medicare Savings Programs, and Dual Eligibility

Although Medicare helps cover the cost of healthcare, there are still out of pocket costs, such as premiums, deductibles, and copays. If you have limited income, there are programs available to help.

There are four total Medicare Savings Programs (MSPs).

Three out of the four programs are available if you have Medicare and are at least 65 years old. If you qualify, these programs help you with the cost of Medicare. Local states run the programs, and each program has different income requirements for eligibility.

Qualified Medicare Beneficiary (QMB) Program

The Qualified Medicare Beneficiary Program can assist with out of pocket Medicare costs, such as premiums and deductibles.

If you qualify for this program, you receive government financial assistance with monthly payments toward your Medicare Part A and Medicare Part B premium payments. The Qualified Medicare Beneficiary Programs also covers deductibles, co-insurance, and some prescription costs.

Specified Low Income Medicare Beneficiary (SLMB) Program

The Specified Low Income Medicare Beneficiary Program helps to cover Medicare Part B premium costs.

Qualifying Individual (QI)

The Qualifying Individual Programs also assist with the cost of Medicare Part B premiums.

Benefits are limited and available to those who apply first. They give preference to those who were covered under the program the previous year. You must complete the application annually, even if you were accepted the year before.

Qualifying Disabled and Working Individuals (QDWI) Program

The Qualifying Disabled and Working Individuals Program helps pay for Medicare Part A premiums. Each state's Medicaid program runs the Qualifying Disabled and Working Individuals Program. If you are disabled, under 65, and currently working, you may qualify for this program.

Low Income Subsidy

The Medicare Part D Extra Help Program, also known as the Low Income Subsidy, helps low income individuals pay for prescription drugs.

If you receive both Medicaid and Medicare, you are dual-eligible for benefits. Consequently, you automatically qualify for Extra Help.

Anyone who receives Supplemental Security Income (SSI) or is eligible for a Medicare Savings program qualifies for Medicare Extra Help.

Dual Eligibility Program

Dual Eligibility refers to a person who receives both Medicaid and Medicare. Medicaid and Medicare are very different, so it's good to know which one does what.

Medicaid is an assistance program for people with low incomes and is mostly operated by states.

On the other hand, Medicare is a federal health insurance program for seniors and disabled people.

People who are eligible for both Medicaid and Medicare can receive better healthcare coverage and pay lower costs for insurance.  

AARDY Can Help

AARDY is the nation's fastest Medicare insurance marketplace. We can help you review your Medicare options even if you're still working after 65.

You can compare Medicare supplements and Medicare Advantage plans to find the one that best fits your needs.


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