Medicare & Employer Benefits: Frequently Asked Questions

Your employer's plan is creditable if it's expected to pay at least as much as standard Medicare Part D. Starting January 1, 2027, that standard rises to 73% of expected drug costs (up from 60% before 2026). Your employer's annual notice, sent before October 15 each year, will tell you whether your plan meets it.

The federal threshold for Creditable Coverage jumps from 60% to 73% on January 1, 2027 under CMS Final Rule 4208-F3. Plans that comfortably cleared the old bar may no longer qualify — worth confirming before your next renewal.

If you go 63 or more consecutive days without creditable drug coverage after becoming Medicare-eligible, you get a permanent penalty added to your Medicare Part D premium for as long as you have Part D.

If your employer has 20 or more employees, your group plan generally pays first and Medicare pays second for employees 65+. Under 20 employees, Medicare pays first. Different thresholds apply for disability (100+ employees) and End-Stage Renal Disease (30-month coordination period, regardless of employer size).

No. COBRA isn't considered "employer coverage" for Medicare purposes. Delaying Medicare enrollment while on COBRA can still trigger a permanent Part B late enrollment penalty.

No. Federal Medicare law doesn't recognize unmarried domestic partners as spouses. A domestic partner generally can't qualify for Medicare based on their partner's work record, and enrollment timing rules differ.

PAR (Participating) providers accept Medicare's approved rate in full. Non-PAR providers can charge up to 15% more than that rate. Opt-Out providers don't accept Medicare at all — you'd pay 100% of the cost privately.

An ICHRA is a fixed monthly amount your employer gives you to buy your own health insurance — or, if you're enrolled in Medicare Parts A and B, to pay Medicare premiums (Part B, Part D, or Medigap).

IRMAA is an extra amount added to your Part B and Part D premiums if your income is above a certain level, based on your tax return from two years earlier. The standard 2026 Part B premium is $202.90/month, rising in steps to $689.90/month for the highest earners.

The One Big Beautiful Bill Act (OBBBA), effective 2026, made several changes: telehealth is now covered before your HDHP deductible without affecting HSA eligibility, Direct Primary Care memberships are now HSA-compatible, the Dependent Care FSA limit rose from $5,000 to $7,500, and a new tax-advantaged children's savings account became available.