Small Group Coverage and Medicare – Know What to Do

Once again, we write about small group coverage, defined as through an organization of fewer than twenty employees, and Medicare. In most instances, when employed by a small group, one must enroll in Medicare A and B, and the group coverage can serve as secondary coverage.  

Connecticut is the only state we are aware of with legislation that requires a small employer to continue to offer group coverage as primary to everyone, regardless of age.

Connecticut’s small group rule, however, is not the only type of exception to the norm. Some Plan language terminates you from your group coverage at sixty-five. There are also Professional Employer Organizations (PEOs) where the Medicare enrollment requirement does not apply. 

Our advice is to 1) review your Plan Documents, which can usually be found on your personal insurance company portal, so you understand your Plan’s requirements, and 2) determine the best solution for you. It often doesn’t make sense to go on to Medicare A and B and maintain group coverage as secondary, but that depends on your contribution, if dependents are covered by the plan, and how rich the group coverage is. 

And don’t be complacent if you are 65 or over and your small group has continued to pay claims.  If you are not eligible for that coverage to be primary, the insurer can retract claims payment from claims already paid, and create a nightmarish situation for you. 

Your insurance coverage documents are legal contracts. Know what they require.