Medicare coordination. For employees turning 65.

Your employees turning 65, and their spouses, face Medicare decisions that interact with your group plan. Ethos Benefits keeps the plan's Medicare obligations on your calendar, including creditable coverage notices and secondary payer rules, and helps employees understand their choices and timing so they avoid gaps and penalties.

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What you get.

Employees often assume they must sign up for Medicare at 65, or that they can wait without consequence. Either mistake can cost them, and some employer actions around Medicare are restricted by law.

Creditable coverage noticesMedicare Part D creditable coverage notices sent to employees and reported to CMS on time.
Secondary payer rulesThe plan’s obligations under Medicare secondary payer rules reviewed, including who pays first for working employees over 65.
Employee guidanceHelp for employees and spouses approaching 65 in understanding how Medicare works with the group plan and when to enroll.
Plan design reviewPlan rules checked so they do not treat Medicare-eligible employees in ways the law prohibits.

What the plan must do.

Tell participants each year, before October 15, whether the plan’s drug coverage is creditable.
Tell CMS within 60 days after the plan year starts.
Follow Medicare secondary payer rules, which decide whether the group plan or Medicare pays first, and restrict employers from encouraging Medicare-eligible employees to leave the group plan.

What employees need to know.

When to enroll in Medicare, how it works with the group plan, and how to avoid late enrollment penalties. Ethos answers these questions for employees and spouses through employee advocacy.

Part of your Fiduciary Framework™.

Every Ethos service reports to your benefits committee. The work is reviewed at your quarterly committee meeting, each decision is recorded with the reasoning behind it, and the record lives in your Ethos Fiduciary OS. That is what lets your committee show the plan was run prudently.

See the Fiduciary Framework™ · How fiduciary governance works

Sources

Creditable coverage for employers and plan sponsors, Centers for Medicare & Medicaid Services
Coordination of benefits and recovery overview, Centers for Medicare & Medicaid Services

Questions employers ask about this.

Does our group plan pay before Medicare?

For employers with 20 or more employees, the group health plan generally pays first for active employees and spouses age 65 and older. Smaller employers follow different rules.

Do employees have to enroll in Medicare at 65 if they have our plan?

Not always. Employees covered by a large employer’s group plan through current employment can often delay Part B without a late enrollment penalty, but the rules and timing need care. Ethos helps employees understand their situation.

What is creditable coverage?

Drug coverage that is expected to pay at least as much as standard Medicare Part D. Employers must tell Medicare-eligible participants each year whether their coverage is creditable, so they can avoid a late enrollment penalty.

See what your plan is really costing you.

A Strategic Analysis starts with your plan documents and your broker agreement, then shows you what your plan costs, where the risk sits, and what a committee would decide with the full picture.

Request a Strategic Analysis Call (407) 803-4710