Medicare rules worry HR manager

from August of 2023. It has been revised and updated.

Hello Toni:

I am a human resources manager for an oil service company and have a question about an employee. He is turning 65 and is still working full time. His situation is unusual because next month he will begin receiving chemotherapy for lung cancer. I am not sure how to advise him because, technically, he is working full-time. He has accrued 5 months of paid vacation time, which he can use while recuperating that keeps him as a full-time employee.

Our firm has over 100 employees, and I’ve been told there are certain rules for a specific company size. How can I make sure that I have the correct answer to my questions for the employees of our company? Thanks, Toni.

--Katie from Tampa, Fla.

Hi Katie:

Most of the answers about enrolling in Medicare are in the Medicare & You handbook. Many Americans do not take Part B during their Initial Enrolment Period (IEP) when turning 65 because they or their spouse are “still working” with health insurance provided from a current employer. Katie, the IEP for your employee who has cancer begins three months before his 65th birthday and ends three months after his 65th birthday.

Since your employee is still working full-time with employer benefits, I would advise him not to enroll in Medicare until he is no longer working full-time. What a blessing to have 5 months of pay by not using his vacation time. You never know when you may need a leave of absence due to health issues.

Katie, understanding a few Medicare enrollment options can help to make your job easier. You should:

-- Verify your employees’ options by calling your company’s health insurance plan and asking how the plan coordinates with Medicare.

-- Review page 19 of the 2025 Medicare & You handbook under “Should I Get Part B?” to determine if delaying Part B enrollment past 65 is an option for your employees. (Chapter 1 of Toni’s new Medicare Survival Guide Advanced edition, which is available at www.tonisays.com, also discusses this situation.)

You should also review a few of the Medicare rules that decide whether Original Medicare or other insurance pays first. See the chart regarding the number of employees on page 21 in the 2025 Medicare & You handbook under "How does my other insurance work with Medicare?" In essence:

-- If there are 20 or more employees at the company where you or your spouse currently work and get benefits, your group health insurance pays first.

-- If there are fewer than 20 employees at the company where you or your spouse currently work and receive benefits, Medicare pays first. The Human Resource department should verify with the insurance carrier as to how the plan coordinates with Medicare and if the employees should enroll in Medicare Parts A and/or B when turning 65.

Employees should contact their local Social Security office immediately to enroll in Medicare Part B when their work status changes after 65. The employee who has the health issue will need to enroll during a SEP (Special Enrollment Period) when his employment changes from full time to a part time employee, when he decides to retire, or if he is terminated.

Those who decide to enroll in COBRA need to know that COBRA and retiree insurance are not considered current employer insurance. Employees will not have a SEP with these plans if they wait too long.

Katie, when the employee is leaving employment past 65, it is important to have the human resource department complete and sign the CMS-L564 (Request for employment information) form and attach it to CMS-40B (Application for enrollment in Medicare Part B). Write “Special Enrollment Period” across the top of each page, then have the employee file both forms, preferably in person with the specific local Social Security office.

The employee should advise the Social Security representative that they and also their spouse (if the spouse is on their insurance and losing employer benefits) need Medicare Part B to begin ASAP. Write the effective day on the CMS-40B as the first of the month in item 9 of the “Remarks” section of the application.

Katie, you are a good HR manager to be looking out for your employees, because when it comes to Medicare, what they don’t know WILL hurt them.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.