Navigating the complexities of Medicare compliance can be a daunting task for any business, but it’s particularly crucial for those with Medicare-eligible employees. Understanding the group size guidelines for Medicare enrollment is not just beneficial; it’s a legal must-have to avoid potential penalties and ensure that claims are paid promptly.

For Groups with Less Than 20 Employees

Small businesses with fewer than 20 employees need to pay special attention. If you have any employees — or their spouses or dependents — who are approaching or have surpassed the age of 65 or are eligible for Medicare due to a disability, action is required. For these groups, Medicare becomes the primary coverage, not just an option.

This means that eligible individuals must enroll in Medicare as soon as they’re eligible. Failure to do so can lead to a nasty surprise where claims are not paid, and the individual could also be hit with financial penalties for late enrollment. It’s not just a compliance issue; it’s about ensuring employees have the coverage they need when they need it.

For Groups with Less Than 100 Employees

When it comes to mid-sized businesses with less than 100 employees, the rules shift slightly. If an employee — or their spouse or dependent — is Medicare-eligible due to a disability, similar rules apply as with smaller groups. Medicare should be considered their primary coverage, and they must be enrolled in Medicare accordingly.

Again, the repercussions for not enrolling are significant, impacting both the payment of claims and potential penalties for the individuals concerned.

Why This Matters

Adhering to these guidelines isn’t just about following the law. It’s about protecting your employees and their families from unexpected medical costs and coverage gaps. As an employer, you play a pivotal role in providing information and resources to help your employees make informed decisions about their healthcare coverage.