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Group Coverage vs. Medicare – How To Avoid Costly Penalties!

A common topic we see come up often is what to do when you’re about to turn 65 and qualify for Medicare, but you still work and have excellent group insurance coverage. Are you in this situation and don’t know what to do?

Here are a few factors you may want to take into consideration.

Group Coverage vs. Medicare Insurance 

First things first: you need to find out if your group insurance will be primary or secondary. This will ultimately depend on your group plan, the company you work for, and if they require Medicare to be primary. If this is the case, it may be beneficial to go ahead and enroll in Medicare and add on a Medicare Supplement (Medigap) plan because your group plan may not cover as much as you had hoped.

For this example, let’s assume in this case, you can stay in your group insurance plan and it will stay your primary insurance even when you turn 65. The first thing we recommend is that if your group plan is going to be the primary insurance and they’re not requiring you to take out your Medicare Part B, then do not. There is no reason to pay for your group insurance and a Medicare Part B premium if you’re going to use your group insurance. 

If your group plan requires you to be on Medicare, note that you won’t automatically be enrolled in Medicare just because you’re turning 65. If you are drawing Social Security and are already in the Medicare system (which is not likely if you’re still working), then you would be automatically enrolled in your Part B. However, if you’re not drawing Social Security, which is more likely the scenario if you’re still working, you would be required to enroll in Medicare. You can enroll in Medicare through the Social Security website ( or call 1-800-772-1213 (directly to the Social Security office) and let them know you need to enroll in Part B.

What To Do If You Have Group Insurance 

For this example, let’s now say you are 68 and deciding to retire. You’ve been carrying your group insurance plan but don’t know what you’ll do once you are no longer enrolled because you were never enrolled in Medicare. In this scenario, you would contact Social Security or enroll on their website. However, to avoid any late enrollment penalty, your employer or human resources department must fill out a creditable coverage form to prove that you have had creditable coverage since you were 65.

If you are on VA, that is unfortunately not creditable. This means you will need to enroll in Medicare once you become eligible, or you could face late enrollment penalties. 

Now, let’s say you have group insurance and will keep the group insurance, but they will require you to carry your own drug plan. This would be a PDP or a prescription drug plan. In this case, you will want to choose a prescription drug plan that best suits your prescriptions. Fortunately, we have the resources you need to find a PDP that meets your needs.

Give The Benefit Link A Call Today

Suppose you need help with this process or have any further questions. In that case, The Benefit Link is here to serve you! Our Medicare professionals will provide guidance, advice, and resources to ensure you get the best, most affordable coverage possible.

Schedule A Consultation

It can be difficult to know whether or not you have proper coverage, but we can help!

Any questions? Feel free to give us a call.



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