For Utah employers and HR
Your employees will ask you about Medicare. You’re not allowed to answer.
Somewhere between “when should I enroll” and “what happens to my spouse,” HR runs out of road. The rules are genuinely complicated, the deadlines are real, and giving the wrong answer creates liability you don’t want. This page is what you can do instead.
The short version
If you read nothing else
- Under 20 employees, Medicare pays first at 65 — whether or not your employee enrolls.
- Two enrollment windows on two separate clocks: seven months around the 65th birthday, eight months after group coverage ends.
- Sixty-three days after drug coverage ends, or a permanent penalty attaches.
- You can tell an employee the windows exist. You can’t tell them what to do about it.
- Two dates are yours: a creditable-coverage notice before October 15, and a CMS disclosure within 60 days of your plan year.
The rest of this page is the detail behind those five lines. If the box is all you read, you are already ahead of most employers in the state.
The threshold
It starts with one number: how many people you employ
Lower exposure
20 or more employees
Your group plan pays first. An employee can stay on it and delay Part B without penalty while they’re actively working. You may not require or incentivize them to drop group coverage in favor of Medicare.
Higher exposure
Under 20 employees
Medicare pays first, and your plan becomes secondary at 65 — whether or not the employee enrolls. Someone who skips Part B is uninsured for the share Medicare was supposed to cover. Insurers have recovered five and six figures from providers after the fact, who then bill the employee.
The count is generally 20 or more employees for 20 or more calendar weeks in the current or prior year, and it includes part-time staff. If you’re near the line, or in a multi-employer or PEO arrangement, confirm it rather than assuming.
Two clocks
Turning 65 and leaving the company are two different events
This is the part almost everyone gets wrong, including people who have handled benefits for years. There are two separate enrollment windows on two separate clocks. They might open the same week. They might be a decade apart.
Clock one
Turning 65Seven months
Starts at
65th birthday month
Seven months: the three months before the birthday month, the month itself, and the three months after. Coverage starts later if they wait until after the birthday.
A separate clock — these scales do not connect
Clock two
Group coverage endsEight months
Starts at
Coverage based on current employment ends
Eight months to enroll in Part B after coverage based on current employment ends. This is usually retirement, but it also happens on a reduction below benefits-eligible hours, or when the plan itself ends.
Days after creditable prescription coverage ends to pick up Part D before a permanent late penalty attaches.
Where it goes wrong
Five things that catch people out
Open any that sound like someone you employ.
HSA contributionsPart A can be granted retroactively up to six months.
An employee contributing to an HSA during that lookback owes tax penalties. Contributions need to stop roughly six months before they apply for Medicare or Social Security.
COBRA isn’t active coverageIt does not hold the special enrollment window open.
People elect COBRA at 65 believing they’re protected and discover the Part B window closed while they were on it.
Retiree coverage isn’t eitherSame trap.
Only coverage based on current employment keeps that clock from starting.
The younger spouseWhen the employee moves to Medicare, a spouse or dependent on your group plan may lose coverage entirely.
This is the detail that turns a routine retirement into a crisis, and it’s usually found too late.
The penalty is permanentPart B carries roughly 10% added for each full year they could have enrolled and didn’t.
It’s paid every month, for life — not a one-time fee.
What HR can and can’t do
Where the line is
You can
- Tell employees the enrollment windows exist
- Point them to someone who can explain their options
- Complete CMS-L564 promptly — the employment verification form is yours to sign, and a delay can cost them a window
- Share general educational material like this page
You shouldn’t
- Recommend a plan or compare specific coverage
- Tell someone whether or not to enroll
- Pressure or reward a 65-year-old for leaving the group plan, if you have 20 or more employees
You’re pointing, not advising. That distinction is what protects you.
And two dates that are yours, not theirs
- Before October 15, every year
- Notify Medicare-eligible plan members whether your prescription drug coverage is creditable. This is the one that gets missed most often.
- Within 60 days of your plan year start
- Disclose creditable-coverage status to CMS online.
The 65 Handoff
Four steps, installed once
Nearly every problem on this page traces back to the same thing: nobody started the conversation early enough. Four steps fix it — twenty minutes to set up, and every employee turning 65 gets caught for the next decade.
Flag it at 64 and 9 months
Add a reminder wherever you already track anniversaries and reviews. Their enrollment window opens three months before the 65th birthday, and a flag ahead of that gives them time to prepare rather than react.
Send them a short note
Tell them the window exists, that decisions may be needed even if they’re not retiring, and who they can talk to.
Add it to offboarding
Whenever someone leaves, retires, or drops below benefits-eligible hours, coverage ends and the second clock starts. One line on a checklist you already use prevents the most expensive version of this.
Set a September reminder
Your creditable-coverage notice is due before October 15 every year. Same month, every year.
Two ways to get it in place
On your own
Take the templates
I’ll send all four: the employee notice, the line for your offboarding checklist, the September reminder, and the wording for the 64-and-9-months flag. Plain text you can paste into whatever you already use.
Ask for them at james@planwellutah.com or (801) 867-0041, or use the form at planwellutah.com/employers.
With me, in twenty minutes
Have it set up for you
We go through your list together and you leave with all four already in place: the flag set in your system, the notice written in your words, the line added to your checklist, and September in your calendar. On a call or in your office, whichever is easier.
No cost, nothing is sold, and you don’t need to prepare anything.
- Flag it at 64 and 9 months
- Send them a short note
- Add it to offboarding
- Set a September reminder
Who I am
What I do, and how I’m paid
I’m James Briggs, an independent insurance agent licensed in Utah and Idaho. When one of your employees has questions about turning 65 — whether they’re retiring or not — I’ll sit down with them at no cost and walk through what applies to their situation.
If it’s useful, I’ll also spend twenty minutes with you setting up the four steps above.
What it costs you: nothing. Employers pay me nothing, and I’ll never ask you to buy anything. If an employee decides on their own to enroll in a plan through me, the carrier pays a commission set by that plan. Their cost is identical either way. If they’d rather go elsewhere, or use Utah’s free SHIP counseling, I’ll tell them how.
I don’t sell group health insurance, so I’m not competing with your benefits broker.
For your employees
What your people get
Everything here is free and ungated. None of it needs me in the room, and none of it asks your employees for anything.
An employee session
Forty-five minutes with anyone approaching 65
On-site or virtual, for any of your staff heading toward 65 — retiring or not.
No products are discussed, nothing is sold, and no one is asked for contact details.
An HR briefing. Twenty minutes for your benefits team on the compliance boundaries and the two dates above. Usually the same conversation as setting up the handoff.
Or forward an event. I run free public sessions at Utah libraries on health coverage before 65. If you’d rather not host anything, forwarding one of those to employees over 55 costs you nothing.
Twenty minutes
Set up the 65 Handoff
We go through your employee list, set the flags, write the notice in your words, and put September in your calendar. Twenty minutes, once. Most of the employers I do this with never think about it again.
Or just send a note
The twenty minutes, an employee session, or a question about something on this page. Say which and I’ll answer it.