Here’s what you need to know about comparing employer insurance with Medicare, making the right decision, and avoiding costly mistakes.

1. Why Creditable Coverage Matters After Age 65

Medicare requires creditable coverage if you delay enrollment past 65.
If your employer coverage doesn’t qualify as creditable, you could face lifelong late enrollment penalties and coverage gaps.
COBRA is NOT creditable coverage—relying on it can lead to major financial risks.

Key takeaway: Always confirm with your HR department or insurer that your coverage is Medicare-creditable. If it isn’t, enroll in Medicare at 65 to avoid penalties!

2. Medicare vs. Employer Coverage: Which Is Better?

Many people assume staying on an employer plan is better, but that’s not always true. Medicare often provides more comprehensive and cost-effective coverage.

How to Compare Employer Coverage & Medicare

Employer Plan Considerations:
Does your employer have 20+ employees? If not, Medicare automatically becomes your primary coverage.
What are your monthly premiums? Many employer plans cost more than Medicare.
What are your deductibles & out-of-pocket costs? Medicare may cover more at a lower cost.

Medicare Benefits to Consider:
Medicare offers nationwide coverage, while employer plans often have network restrictions.
No referrals required for Medicare Supplement (Medigap) plans.
Medicare Part B costs $185/month in 2025, which may be lower than employer premiums.
Medicare Advantage (Part C) plans include low or $0 premiums, with added benefits like dental, vision, and hearing coverage.

Key takeaway: Compare your total costs, coverage networks, and out-of-pocket expenses—Medicare may be the better choice financially and offer better coverage.

3. The Risks of Non-Creditable Coverage & COBRA

What Happens If You Have Non-Creditable Coverage?

If your employer plan isn’t creditable, or if you rely on COBRA after 65, you risk:

Late Enrollment Penalties: 10% lifetime penalty on Medicare Part B for every 12 months you delay enrollment.
Coverage Gaps: COBRA is not primary insurance after 65—major medical bills may not be covered.
Higher Medical Costs: Employer plans may exclude retirees from certain benefits, leading to higher out-of-pocket expenses.

Key takeaway: COBRA is not a safe alternative to Medicare. If you lose employer coverage after turning 65, enroll in Medicare immediately to avoid gaps.

4. Why Enrolling in Medicare at 65 Is a Smart Move

Lower costs: Medicare may cost less than employer coverage.
Better coverage: No pre-authorizations, nationwide access, and lower deductibles with Medigap.
Peace of mind: No worrying about losing employer coverage or being denied due to health issues.

Medicare Enrollment Periods to Know:

Initial Enrollment Period (IEP): The 7-month window around your 65th birthday.
Special Enrollment Period (SEP): If you delay Medicare due to employer coverage, you have 8 months to enroll after losing your job-based insurance.
General Enrollment Period (GEP): January 1 – March 31, but late penalties apply if you missed IEP/SEP.

Key takeaway: If you don’t have creditable coverage, enrolling in Medicare at 65 is the safest and most cost-effective choice.

5. Retirement & Health Coverage Planning: What to Do Next

Step 1: Verify Employer Coverage – Ask your HR department if your plan is Medicare-creditable.

Step 2: Compare Costs – Calculate your monthly premiums, deductibles, and max out-of-pocket expenses.
Step 3: Plan Your Transition – If retiring soon, enroll in Medicare on time to avoid coverage gaps.

Need Help Choosing a Medicare Plan? Consult a Medicare expert or visit Medicare.gov to compare plans and make the best decision for your retirement!

The post Medicare & Creditable Coverage After 65 appeared first on ROI TV.

1. How Employer Coverage & Medicare Work Together

If you’re still working at 65 or older, your employer health plan is usually the first payer, meaning it covers medical expenses before Medicare pays anything. However, Medicare enrollment timing matters, and delaying Part B could impact your ability to enroll in Medicare Advantage or Medigap later. If your employer has fewer than 20 employees, Medicare becomes the primary payer, making it crucial to enroll in Part A and Part B to avoid gaps in coverage.

2. Comparing Costs: Medicare vs. Employer Coverage

Example: If your employer plan costs $300/month with a $4,000 deductible, it might be cheaper to switch to Medicare with a Medigap or Advantage Plan. If your employer covers dependents, keeping employer coverage might be better for family coverage.

3. Should You Keep Employer Benefits Like Dental & Vision?

If your employer offers separate vision and dental coverage, you may keep those benefits while switching to Medicare for medical coverage. Medicare doesn’t cover routine dental or vision unless medically necessary. You can purchase standalone dental & vision plans if you leave employer coverage. If your employer lets you keep only dental/vision benefits, you can still switch to Medicare for better medical coverage while maintaining other perks.

4. When Does It Make Sense to Switch to Medicare?

Switching to Medicare is usually a smart financial decision if your employer coverage is expensive and Medicare offers similar or better benefits, you don’t need family coverage through your employer, you want broader provider access (Medigap allows you to see any Medicare doctor), or you’re worried about rising employer plan costs in retirement.

When to Keep Employer Coverage: If you need coverage for your spouse or dependents, if your employer offers premium discounts that make it more affordable than Medicare, or if you plan to retire after 65 but before 70, and your employer offers bridge coverage.

5. Avoid Medicare Enrollment Mistakes

If you delay Medicare enrollment past 65 without employer coverage, you may face late enrollment penalties for Part B and Part D.

Key Enrollment Rules: If your employer has 20+ employees, you can delay Part B without penalties. If your employer has fewer than 20 employees, Medicare becomes primary, and you must enroll in Part B. When you leave your job, you have 8 months to enroll in Medicare without penalties.

6. Next Steps: How to Choose the Best Option

Compare your employer’s costs (premiums, deductibles, out-of-pocket max) to Medicare + Medigap/Advantage costs. Ask your employer’s HR department if your health plan will continue past 65 and if dependents can stay covered. Enroll in Part B & Medigap/Advantage on time to avoid penalties and delays in coverage.

Need help picking a Medicare plan? Visit MedicareSchool.com to explore your options!

Final Thoughts: Should You Switch to Medicare?

Deciding whether to keep employer health insurance or switch to Medicare depends on cost, coverage needs, and family considerations. For many people, Medicare is more cost-effective and offers better network flexibility, but if you have family members on your employer plan, you might want to keep it a bit longer.

Have you switched from employer coverage to Medicare? Let me know your experience in the comments!

The post Medicare vs. Employer Coverage: Which One is More Cost-Effective? appeared first on ROI TV.