At age 65 employees have the choice to leverage their Medicare eligibility on their own with an individual plan, or they can choose to stay on the group plan as is.   Individual plans are generally less than half the cost in gross premium and usually provide better coverage as well.   To transition to individual Medicare, they would need to elect Medicare Part B, whereas in most cases employees who choose to stay on the group plan can delay their Part B election until a later date without penalties or waiting periods. 

If you remain on your employer’s health plan, claims will be paid the same as always, no differently than any other employees on the same plan.  Carriers are not allowed to pay the claim differently based on Medicare eligibility, that’s discrimination.  That said, the carrier will often coordinate with Medicare when paying the claim, but that process is seamless to you the member and takes place behind the scenes.   Example: with a hospital claim, the carrier will pay the hospital as per the plan benefit, but then they will send a claim to Medicare to cover any portion for which Medicare may be responsible. 

If you lost your group health insurance coverage, we can provide assistance to understand your options. We will compare the different plans and find the right coverage to fit your needs. You can also use our simple enrollment tool; place the health insurance tool link here.

Many insurance plans provided by employers still leave a financial gap. Employer-sponsored plans usually only pay for a portion of your base salary, up to a cap. We recommend you consider supplementing your group coverage.