As individuals hit 65, they qualify for Medicare, sparking employer obligations regarding healthcare coverage. Although most become eligible regardless of employment, certain factors determine if they can postpone enrollment while staying on the employer’s healthcare plan.

Delaying Medicare Enrollment

Active employees under an employer-sponsored health plan can opt to delay Medicare enrollment without penalties. This rule only applies to those working for larger companies (employing more than 20 workers).

Employer Responsibilities

Employers bear legal obligations when senior workers participate in the company’s group health insurance. This encompasses ensuring adherence to Medicare regulations, offering precise details on Medicare enrollment choices to employees, and appropriately coordinating benefits. Additionally, employers must inform Medicare of any alterations to the group health plan coverage or changes in employee employment status, which may necessitate compliance with Medicare enrollment criteria.

Employers must ensure compliance with Medicare rules, providing accurate information on enrollment options and coordinating benefits. They must notify Medicare of plan changes or shifts in employee status triggering Medicare enrollment.

Compliance with Medicare Rules

Employers must ensure their group health insurance plan aligns with Medicare secondary payer rules, coordinating benefits and avoiding discrimination based on Medicare eligibility.

Supplying a Notice of Creditable Coverage

If the employer’s healthcare plan includes prescription drug benefits, it must confirm coverage meets or exceeds Medicare’s standard. Employers offering such benefits must inform Medicare annually via a Notice of Creditable Coverage, aiding eligible individuals in deciding on Medicare Part D enrollment.

Timely Notification

Notification must be provided to Medicare within set timeframes, typically before October 15th each year, or any time changes to the plan will affect the coverage’s creditable status. Failure to do so accurately and promptly can lead to penalties.

Supporting Senior Workers

Understanding and adhering to Medicare regulations enables employers to assist senior workers in accessing appropriate healthcare coverage while fulfilling legal obligations. For guidance on compliance, contact us so we can review your coverage and ensure legal compliance.