What If You’re 65 and Not Ready for Medicare?

For many retirees, filing for Medicare is an important milestone. You’ve likely been paying into the system for decades. Now that you’re approaching retirement, you may be ready to start benefiting from the Medicare system. Most people are eligible for Medicare at age 65, and many enroll in their first available enrollment period.

However, you may not be ready to transition to Medicare coverage. Perhaps you plan on staying in your current job for a few more years and prefer your employer coverage. You may have access to an HSA that you want to keep funding. Or maybe you own a small business and would prefer to stay on the group plan.

The rules for Medicare enrollment can be complicated, so there’s no simple solution that works for everyone. You may be able to avoid Medicare enrollment, but it depends on a few factors. One of the biggest is whether you have any control over your group plan. If you are an employee participant, and not an owner, your options may be limited.


For Employees

If you’re an employee, your first step should be to check with your employer’s group plan administrator. Every plan has different rules about how it integrates with Medicare. For example, some plans have rules that participants who are Medicare-eligible must exit the group plan and enroll in Medicare coverage. Generally, these tend to be smaller plans. However, large plans may have the same requirement.

Other plans offer exceptions and allow participants to stay on the group plan even if they are eligible for Medicare. Again, these generally tend to be larger plans with many participants, but that isn’t always the case.


For Owners

If you are an owner rather than an employee, you may have more flexibility. Obviously, as an owner, you have some control over the group plan. You may be able to negotiate terms and exceptions directly with your plan carrier. If you can’t get an exception through your carrier, there are two alternate routes to consider:

Shop for a new plan. Buying a new plan is always an option. You could shop for a plan that doesn’t force you onto Medicare. However, consider that switching plans could raise premiums, and it might cause stress and disruption for your employees. Also consider that you may need to buy a plan that’s meant for larger businesses in order to get the exception.

Join a multiemployer plan. Another option is to join a multiemployer plan. In these plans, multiple small businesses group together to leverage the benefits that are usually only available to large companies. Multiemployer plans are often available through unions, trade groups, chambers of commerce and other organizations.

Not sure how to navigate your health care requirements in retirement? Contact us at TB Financial. We welcome the opportunity to help you analyze your needs and develop a strategy. Let’s connect today.


This information is designed to provide a general overview with regard to the subject matter covered and is not state specific. The authors, publisher and host are not providing legal, accounting or specific advice for your situation. By providing your information, you give consent to be contacted about the possible sale of an insurance or annuity product. This information has been provided by a Licensed Insurance Professional and does not necessarily represent the views of the presenting insurance professional. The statements and opinions expressed are those of the author and are subject to change at any time. All information is believed to be from reliable sources; however, presenting insurance professional makes no representation as to its completeness or accuracy. This material has been prepared for informational and educational purposes only. It is not intended to provide, and should not be relied upon for, accounting, legal, tax or investment advice.

16162 – 2016/10/18

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