If you’re approaching 65 and still working — or covered through your spouse’s employer — you’ve probably wondered:

“Do I stay on my employer’s plan or switch to Medicare?”

It sounds simple, but it’s one of the most misunderstood questions people ask every year.

The Confusion

You might have heard:

• “If you’re still working, you don’t need Medicare.”

• “You’ll get a penalty if you delay.”

• “You can’t have both.”

The truth? All of those statements can be right — or wrong — depending on your situation.

It all depends on who the employer is, how the plan is set up, and whether Medicare is considered primary or secondary.

The 20-Employee Rule

Here’s the starting point:

• Large Employer (20+ employees):
  
  The employer’s plan is primary and Medicare is secondary.
  
  You can delay Medicare Part B without penalty if your coverage is considered creditable.

• Small Employer (fewer than 20 employees):
  
  Medicare is primary, and your employer’s plan becomes secondary.
  
  That means if you skip Part B, your employer plan may not pay most of your medical bills — or any at all.

This single rule changes everything.

The Cost Factor

Some people assume keeping their employer coverage will save them money. But once you turn 65, that’s not always the case.

When you add up:

• Higher employer premiums,

• Deductibles,

• Co-pays,

• and potential penalties later for delaying Part B —

you might actually find that Medicare with a Supplement or Advantage plan costs less and provides stronger nationwide coverage.

On the other hand, if your employer covers most of your costs or you have access to a rich group plan (especially through a spouse’s job), staying put could make sense for now.

That’s why a side-by-side comparison is key.

The Coordination Trap

If you stay on your employer plan, make sure you know:

• Who pays first: Medicare or your employer.

• Whether your coverage is creditable: Does it meet Medicare’s standards?

• What happens when you leave work: Will COBRA or retiree coverage count? (Hint: COBRA is not creditable for delaying Part B.)

Even if your plan says it will “coordinate with Medicare,” it’s critical to read the fine print.

Some small-group plans say they’ll pay secondary to Medicare — regardless of whether you’re enrolled.

That means you could be responsible for what Medicare would have paid.

How to Decide

Here’s a simple 3-step plan:

1. Confirm your employer size.
   
   Is it 20 or more full-time employees? This determines who pays first.
   

2. Ask your HR department for a “Creditable Coverage” letter.
   
   This will confirm whether your plan meets Medicare’s standards for delaying Part B and Part D.
   

3. Compare your costs and benefits.
   
   Have a licensed broker review both your employer plan and your Medicare options side by side.
   

A Real-Life Example

We recently helped a couple where the husband was still working for a small business with 12 employees. Their group plan looked good on paper, but the fine print said it would pay secondary to Medicare. Once he turned 65, the plan stopped covering what Medicare would have — even though he hadn’t signed up yet.

By enrolling in Medicare Parts A and B and choosing a Medicare Supplement, they actually saved over $1,500 a year and eliminated future penalties.

The Bottom Line

If you’re turning 65, don’t assume your employer plan is your best or safest option.

Ask the right questions before you make a move, because the cost of guessing wrong can be thousands in unpaid bills or permanent late penalties.

At Mere, we help you navigate these rules so you can make a confident, informed decision — without the confusion.

📞 Call 904-654-5450 or visit www.merebenefits.com to schedule a no-cost consultation today.

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