If my client is still working, has ESI, and becomes eligible for Medicare at age 65, do they have to enroll in Medicare?

If a client is still working and turns 65, they can delay enrolling in Medicare Part B until they lose their employer-based coverage, as long as the employer-sponsored coverage meets a set of minimum standards. They can enroll in premium-free Medicare Part A at any time once they become eligible.

If a client has employer-sponsored coverage for themselves or via a spouse, they can keep that coverage and still enroll in Medicare. Having both employer-sponsored coverage and Medicare may reduce the client’s out-of-pocket costs. Whether Medicare will be the primary payer (i.e., whether Medicare will pay claims first and the employer-sponsored coverage pays remaining out-of-pocket costs for the client) will depend on the size of the employer and whether the client or the client’s spouse is currently employed.

For any non-group health coverage (including retiree benefits that a client may receive from a past employer), the client should reach out to the retiree plan to determine how and if the plan would interact with Medicare.

Once they retire and their employer insurance ends, they will have an eight-month Medicare Special Enrollment Period (SEP) in which to enroll in Medicare coverage with no penalties.