Medicare Secondary Payer rules decide whether Medicare or the group health plan pays first when a person has both. For employers with 20 or more employees, the group plan is generally primary for active employees age 65 and older.
It depends on employer size. If your (or your spouse’s) employer has 20+ employees, that plan usually pays first and you can delay Part B without penalty. If the employer has fewer than 20 employees, Medicare typically pays first, so you generally should enroll in Part B at 65.
No. Under the Medicare Secondary Payer rules, an employer with 20 or more employees cannot require, pressure, or financially incentivize a Medicare-eligible active employee to drop the group plan in favor of Medicare. Doing so can trigger a civil money penalty of $11,823 per violation in 2026.
It depends on your employer’s size. If your employer has 20 or more employees and you have active group coverage, you can usually delay Medicare without penalty. If the employer has fewer than 20 employees, Medicare generally pays first, so you should enroll at 65 to avoid gaps and penalties.
For active employees 65+, the employer plan pays first if the employer has 20 or more employees, with Medicare second. If the employer has fewer than 20 employees, Medicare pays first. Disability-based Medicare uses a 100-employee threshold, and ESRD has its own 30-month coordination period.