Group Medicare: A Cost-Effective Health Insurance Solution for Employees Over 65

Why Choose Group Medicare?

• Lower costs than traditional group plans for employees over 65 and group health insurance.
• Comparable coverage to Individual Medicare Advantage Plans with added employer benefits.
• Includes lower Maximum Out-of-Pocket (MOOP), medical deductibles, and hospital deductibles.
• Extra benefits like no-cost gym memberships and wellness programs.

Group Medicare can be an ideal way for businesses to continue offering health benefits while reducing costs.

Compare Group Medicare vs. Traditional Plans

Who Can Enroll in Group Medicare?

• Employees aged 65 and older who are eligible for Medicare.
• Employers of any size who want to provide a cost-effective option for their Medicare-eligible employees.
• Businesses looking for a way to reduce health insurance costs while maintaining employee benefits.

A Group Medicare plan is not required; some employers instead will offer a payroll subsidy, allowing employees to enroll in an individual Medicare plan on their own while still receiving a company-sponsored benefit.

Key Features of Group Medicare Plans

• Lower Out-of-Pocket Costs – More predictable expenses for employees compared to staying on traditional group plans.
• Broader Prescription Drug Coverage – Covers some Specialty Administration Drugs (SAD) that traditional Medicare plans do not. View the SAD List
• Flexible Enrollment – Can start on the 1st of any month throughout the year.
• Administrative Simplicity – Aligning Group Medicare with other employer health plans reduces tracking and administrative complexity.

A Group Medicare plan can be structured to fit your business needs while maximizing benefits for your Medicare-eligible employees.

Find Out If Group Medicare Is Right for Your Business

The Underwriting & Enrollment Process

Clear Benefits Advisors streamlines the group health insurance application process by reviewing all required documents before submission to the carrier.

What to Expect When Applying for a New Plan:

• Employers submit required documentation.  For Example:
  • Prior Year Tax Return
  • Payroll NYS-45 statement
  • EIN & SIC numbers
  • Enrollment forms for companies and employees
  • Waiver forms
  • Rate Sheet Confirmations
  • Enrollment Eligibility form
• Clear Benefits Advisors reviews paperwork to minimize delays.
• The insurance carrier’s underwriting team usually requests additional information before final approval.
• Once approved, coverage begins on the 1st of the chosen month and renews annually on that date.

Enrollment Timing & Process

To ensure a smooth and timely enrollment, employers and employees must adhere to strict deadlines.

• All paperwork must be submitted to the insurance company by the 15th of the month prior for the plan to start on the 1st of the following month.
• To allow time for review, we request that all paperwork be submitted to Clear Benefits Advisors by the 1st of the month prior to the start date.
• If any documentation is incomplete, we will notify you promptly to avoid delays in plan approval.

Submitting paperwork early ensures a hassle-free process and prevents last-minute issues with enrollment.

Employers should consider aligning Group Medicare with their existing health plan renewal dates for ease of administration.

Start the Enrollment Process

Payroll Subsidy for Individual Medicare Plans

If Group Medicare is not a fit, employers may choose to provide a payroll subsidy to help employees purchase their own Medicare plans.

• Employees gain flexibility to choose their own Medicare Advantage or Medigap plan.
• Employers still provide a valuable health benefit but reduce administrative overhead.
• Payroll subsidy amounts are determined by the employer and managed through the company’s payroll system.
• Clear Benefits Advisors can assist employees in selecting the right Medicare plan for their health needs.

Employers must coordinate payroll reimbursement through their payroll company.

Why Work With Clear Benefits Advisors?

• We help employers navigate Group Medicare plan selection and compliance.
• We work directly with employees to educate them on their Medicare choices if they go direct.
• We provide ongoing support to ensure a seamless transition to Medicare.

Whether you choose Group Medicare or an individual subsidy model, we’ll guide you through the best solution for your business.

Schedule a Free Employer Consultation