FAQs

Transitioning Employees Over 65 to Medicare

Navigating health insurance for employees over 65 can be complex, but it can also provide significant cost savings and better benefits for both employers and employees. Below are the most common questions about transitioning eligible employees to Medicare-based group plans.

Can employees over 65 stay on our employer-sponsored health plan?

Maybe…

Yes, if you have more than 20 employees and the company offered plan is considered Creditable Coverage. However, businesses choose to transition eligible employees to Medicare-based group plans because they often offer lower monthly premiums, richer benefits, and no employer mandate penalties for Medicare-eligible employees.

No, if you have less than 20 employees and/or company’s health plan is not Creditable.

Employers with 50 or more employees must offer affordable health insurance, but this mandate does not apply to employees over 65 if they have access to Medicare. Employees cannot be forced to enroll in Medicare, but voluntarily switching can lower costs. In addition, some insurance companies will require employees to enroll in Part A and B to offset their costs and have Medicare be the first payer before the employer health insurance policy.
  • Employers with fewer than 20 employees: Medicare is primary, and employer coverage is secondary. Employees should enroll in Medicare Part A and B or be subject to paying the Medicare covered portion. In addition, they will be issued a lifetime Part B and D Late Enrollment Penalty.
  • Employers with 20 or more employees: Employer-sponsored coverage is primary, and Medicare is secondary. Employees may delay Medicare Part B if they have creditable employer coverage.
Many employers save on healthcare costs while maintaining high-quality benefits. Employees often have lower out-of-pocket costs, better provider access, and more flexible plan choices, including coverage for prescriptions, vision, dental and additional benefits such as gym memberships and Over-The-Counter (OTC) allowances.

Yes, transitioning the employee to Medicare may affect dependents’ eligibility for the employer’s health plan. Options for dependents and spouse include:

  • Employer keeping dependents on the company plan, if allowed by insurance policy.
  • Enrolling in an individual ACA plan for spouses and dependents under 65.

Have us help your employee. Helping individuals bridge the gap to Medicare is a specialty of ours.

To ensure a smooth transition, businesses can provide Clear Benefits Advisors’ Medicare 101 education sessions to employees, sponsor a private Medicare 101 Lunch and Learn for your employees through us, offer Group Medicare plans, and share our contact info with employees for them to schedule one-on-one consultations to help make informed choices.

Schedule a No-Cost Medicare Consultation for Your Business

Need Help Transitioning Employees to Medicare?

If you’re considering transitioning employees over 65 to Medicare-based group coverage, we’re here to help. Our experts can evaluate your current plan, explore cost-saving options, and ensure compliance with Medicare and employer coverage rules.