The 20-employee rule
| Your coverage at 65 | Who pays first | Need Part B now? |
|---|---|---|
| Your or your spouse's current job, employer with 20 or more employees | The job-based plan | No, you can usually delay |
| Your or your spouse's current job, employer with fewer than 20 employees | Medicare | Usually yes |
| COBRA or retiree coverage | Medicare | Yes |
Ask your employer's benefits office, in writing, whether its plan pays first for workers 65 and older. A small employer's plan may pay only after Medicare, which leaves large bills if you skip Part B. If you contribute to a health savings account (HSA), note that once you enroll in Medicare, even Part A alone, you can no longer contribute to it.
Signing up later without a penalty
- Plan ahead. Your special enrollment period lasts until 8 months after the job or the group coverage ends, whichever comes first. Apply before your coverage ends so there's no gap.
- Get form CMS-L564 from your employer. It shows the dates of your group coverage from current work.
- Send it with form CMS-40B to Social Security.
- Choose your other coverage. Your 6-month Medigap open enrollment starts when your Part B starts. Florida has no Medigap birthday rule, but it does give you 2 months after group coverage ends to buy Medigap with no health questions.
Miss the 8-month window and you'll wait for the General Enrollment Period (January 1 to March 31), and you may pay 10% more for Part B for each full 12-month period you could have had it, usually for as long as you have Part B.
Florida public employees
- Retiring from the State: State Group Insurance pays after Medicare for Medicare-eligible retirees, "even if you don't sign up" for Part B, the State says, so have Part B in effect when you retire. See Florida state retirees and Medicare.
- Counties, cities and school districts: Florida law (s. 112.0801) lets retirees stay on their former employer's group plan, often paying the premium. Ask the benefits office how its retiree plan works with Medicare before you retire.
More on working past 65. To review your options when you retire, you can request a call from a licensed insurance agent.
Related questions
Do Florida state retirees need Part B?
What State Group Insurance expects.
How do I find a doctor who accepts Medicare?
Care Compare and two questions.
How does Medicare work in The Villages?
Three counties, three plan lists.
Why won't some Florida doctors take new Medicare patients?
What to do when a practice says no.
Sources
- Medicare.gov — Which insurance pays first?
- Medicare.gov — When does Medicare coverage start?
- CMS — Form CMS-L564, Request for Employment Information
- CMS — Form CMS-40B, Application for Enrollment in Medicare Part B
- eCFR — 42 CFR 407.20, Special enrollment period for group health plan coverage
- IRS — Publication 969, Health Savings Accounts
- Florida Division of State Group Insurance — Retirees
- Florida Statutes — s. 112.0801, Group insurance; participation by retirees
- Florida Statutes — s. 627.6741, Medicare supplement issuance
More questions in this guide
- Can a Florida doctor charge an annual concierge fee if I have Medicare?
- Why won't some Florida doctors take new Medicare patients?
- How does Medicare work in The Villages, Florida?
- How do I find a doctor who accepts Medicare in Florida?
- How do I find a Spanish-speaking doctor who takes Medicare in Florida?
Part of the guide: Medicare in The Villages and Florida's 55+ communities · All questions
Frequently asked questions
Does COBRA let me delay Part B?
No. Medicare.gov says COBRA isn't considered group health plan coverage for this purpose, and getting COBRA doesn't change when your 8-month special enrollment period ends. Sign up for Part B when your job ends, even if you take COBRA.
I'm retiring from the State of Florida after 65. Do I need Part B?
Yes, before you retire if you plan to keep State Group Insurance. The State says its plan pays after Medicare for Medicare-eligible retirees even if they don't buy Part B, leaving you to pay roughly the 80% share Medicare would have paid.
What forms do I need to sign up later?
Form CMS-40B, the Part B application, and form CMS-L564, which your employer completes to show your group coverage from current work. Social Security takes them online, by mail or fax, or at an office.
Medicare in your Florida county
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