Blog Article
Medicare-Eligible Employees: What Employers Need
Medicare For Employers
How Medicare Impacts Your Business and Team
Employees can have both employer coverage and Medicare. We help employers understand group Medicare and Medicare Secondary Payer rules, and and guide Medicare-eligible employees through coverage choices.
Understanding Your Role
What Is Group Medicare for Employers?
Group Medicare is how an employer’s group health plan works alongside Medicare for employees and retirees who are Medicare-eligible. It can also mean group-sponsored Medicare coverage for retirees, such as a group Medicare Advantage plan. Employer size and whether the employee is still working determine which plan pays first, under Medicare Secondary Payer rules.
OneDigital Advanced Health partners with HR and benefits leaders to simplify group Medicare guidance, empower employee decision-making, and support broader group health strategy goals. With our support, employers can:
- Provide education to Medicare-eligible employees
- Align Medicare with broader employee cost strategies
- Understand Medicare Secondary Payer rules and how they apply to your group health plan
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
What Employers Can Expect
Give team members approaching Medicare get the help they need with:
- One-on-one consultations tailored to employee needs
- Education around dependent coverage and enrollment timing
- Guidance on whether employees can keep both employer coverage and Medicare, and how the two coordinate
Medicare education can complement your long-term benefits strategy through:
- Evaluating cost implications of Medicare-eligible participants
- Designing thoughtful transition strategies for group Medicare and retiree coverage
- Enhancing employee satisfaction while managing risk
Speak with a licensed insurance agent for Medicare guidance. We offer:
- Free consultations with no obligation to enroll
- Step-by-step support throughout the enrollment process
- Guidance on Medicare Secondary Payer reporting and eligibility tracking
- Insights on how plan availability, carrier networks, and coverage can vary by state
Connect with an Agent
Talk to a Licensed Agent About Medicare for Employers
(312) 238-0680 | TTY/TDD: 711
We're here to assist you in navigating your options.
Hours of operation (M-F 8am CST to 6pm CST). By calling this number, you will be connected with a licensed insurance agent.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Why Medicare Matters for Your Workforce
19.1%
of Americans age 65+ are still in the labor forceAs more Medicare-eligible employees keep working, employers need a plan for how their healthcare and benefits needs change, including which plan pays first under Medicare Secondary Payer rules.
$1,000/day
in potential CMS penalties, per claimant, for Medicare Secondary Payer reporting failuresGroup health plans that fail to meet Medicare Secondary Payer Section 111 reporting rules can face civil money penalties of up to $1,000 per day per claimant, adjusted annually for inflation.
Medicare for Employers FAQ
Answers to common questions about group Medicare, Medicare Secondary Payer rules, and supporting Medicare-eligible employees.
Group Medicare is Medicare coverage that works with, or is sponsored through, an employer’s group plan. For active employees, the group health plan may pay before or after Medicare, depending on company size. For retirees, an employer can sponsor group Medicare coverage, such as a group Medicare Advantage plan, in place of or alongside retiree group health benefits. Our advisors help employers compare these options and evaluate the cost of each.
Plan availability and benefits vary by carrier and service area.
Yes. Employees can have both employer coverage and Medicare, and which one pays first depends on company size, whether the employee is still working, and how Medicare Secondary Payer rules apply to your plan. Employers with 20 or more employees generally must offer employees aged 65 and older the same group coverage as younger employees, and the group plan pays first,, while smaller employers (with less than 20 employees) may see Medicare as primary. Our advisors help evaluate each situation and determine the best approach for both your business and your employees.
Learn more by reading: What to Know About Medicare-Eligible Employees and Your Group Health Plan
Plan availability and benefits vary by carrier and service area.
We recommend beginning conversations 6–12 months before an employee turns 65. This timeframe allows employees to understand their options, compare employer plan integration, and avoid late enrollment penalties. Employers benefit by proactively planning for coverage transitions, understanding how Medicare eligibility may impact group benefits, and providing clear guidance so employees can make informed decisions about their healthcare.
Plan availability and benefits vary by carrier and service area.
Consultations are provided at no cost to your organization or employees. OneDigital’s team of experts helps you navigate complex rules, educate staff, and support informed decisions. Offering guidance proactively can improve employee satisfaction, prevent costly mistakes, and demonstrate that your organization values healthcare clarity during this important life transition.
Plan availability and benefits vary by carrier and service area.
Employers must follow Medicare Secondary Payer rules and report accurately under Section 111 to avoid penalties. Responsibilities include understanding coordination of benefits, tracking Medicare eligibility, and submitting required notifications. OneDigital works with your team to clarify employer responsibilities, support understanding of Medicare rules, and provide guidance on reporting and eligibility processes.
Learn more by reading: What Employers Need to Know When Their Employees Become Medicare-Eligible
Plan availability and benefits vary by carrier and service area.
Speak to a licensed agent today.
We're here to assist you in navigating your options.
1-888-530-2586 | TTY/TDD: 711
Hours of operation (M-F 8am CST – 6pm CST)
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Plans are insured or covered by a Medicare Advantage (HMO, PPO and PFFS) organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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