Does Medicare pay first if my employer has fewer than 20 employees?

Yes. When your employer has fewer than 20 employees, Medicare is the primary payer at 65 — regardless of whether you are actively working and have employer coverage.

Should I enroll in Part B if I work for a small employer?

Yes. Enroll in Part B during your Initial Enrollment Period. Without Part B, your employer plan pays secondary and covers very little — leaving you responsible for most outpatient costs out of pocket.

Can I face a penalty for delaying Part B at a small employer?

Yes. Small employer coverage does not qualify as the type of active employer coverage that lets you delay Part B without penalty. Delaying may result in a permanent 10% per year late enrollment penalty.

Is there a Special Enrollment Period when I leave a small employer?

The standard 8-month SEP only applies when your employer had 20 or more employees. With a small employer, you should have enrolled during your IEP at 65. If you did not, you may need to wait for the General Enrollment Period and face a permanent penalty.

What does Medicare being the primary payer mean for small employer coverage?

It means Medicare is supposed to pay first — before your employer plan — for covered services at 65. If you have not enrolled in Part B, Medicare has no obligation to pay, and your employer plan may deny claims or pay very little, leaving you with the full bill.

Does the under-20 rule apply if I am covered under a spouse's small employer plan?

Yes. The same rule applies when coverage is through a spouse's small employer (fewer than 20 employees). Medicare is the primary payer at 65 regardless of whose employer provides the plan. Enroll in Part B during your Initial Enrollment Period.

Employer Under 20 Employees and Medicare: Enroll in Part B at 65

When your employer has fewer than 20 employees, Medicare is your primary payer at 65 — even while working. Without Part B, your employer plan covers almost nothing. Enroll during your IEP to avoid permanent penalties and coverage gaps.

Frequently Asked Questions

Does Medicare pay first if my employer has fewer than 20 employees?: Yes. When your employer has fewer than 20 employees, Medicare is the primary payer at 65 — regardless of whether you are actively working and have employer coverage.
Should I enroll in Part B if I work for a small employer?: Yes. Enroll in Part B during your Initial Enrollment Period. Without Part B, your employer plan pays secondary and covers very little — leaving you responsible for most outpatient costs out of pocket.
Can I face a penalty for delaying Part B at a small employer?: Yes. Small employer coverage does not qualify as the type of active employer coverage that lets you delay Part B without penalty. Delaying may result in a permanent 10% per year late enrollment penalty.