Employer Over 20? Who Pays First With Medicare
Usually the employer group health plan pays first if the coverage is based on current active employment and the employer has 20 or more employees. Medicare usually pays second. Confirm details with the benefits administrator.
Frequently Asked Questions
- Can I safely delay Part B if my employer has 20 or more employees?
- Yes. As long as you are actively working and your coverage is based on current employment with an employer of 20 or more employees, you may delay Part B without a penalty. You have an 8-month SEP after employment or coverage ends.
- What happens to coverage order when I retire?
- When you stop working or lose active-employer group health coverage, you have an 8-month Part B Special Enrollment Period. After that window closes, Medicare is no longer secondary -- it becomes your primary payer. Enroll in Part B before or right after employment ends.
- Does the 20-employee rule apply to my spouse's coverage?
- Yes. If you are covered under a working spouse's employer plan and that employer has 20 or more employees, the same rule applies. The employer plan pays first for you as long as your spouse is actively employed and the coverage is based on that employment.