Question: I have a Medicare Advantage plan with Part D. My spouse got a new job and it will provide us both with health insurance. Can I drop my Medicare Advantage Plan and my Medicare Parts A & B?

Answer: I have come across this scenario a couple of times recently.

Your decision to enroll into a Medicare Advantage Plan was an appropriate decision to make, but now things have changed with your newly available employer coverage. The answer to your question could be yes or no, depending on a few different variables. Each part of Medicare has a slightly different answer as well, so I will review the answer according to the different part of Medicare.

Medicare Part A has no premium for most Americans, and if you are collecting Social Security Benefits you cannot refuse Part A. When you collect Social Security you will always have Medicare Part A. Having Medicare Part A does not mean you cannot enroll into an employer sponsored health insurance plan. If the employer group is larger than 20 employees, your Medicare Part A would be secondary, and it comes with no premium. If the employer group is less than 20 employees your Medicare Part A would be primary, and you may not want to join the employer coverage. But we will cover this more later.

Medicare Part B for most Americans has a premium and in 2025 that base premium is $185 per month. If your spouse’s new employer group is more than 20, and you decide to enroll into the employer health insurance plan, you would be allowed to drop your Medicare Part B coverage and your Medicare Advantage Plan also. This would save you the Medicare Part B premium and any other premiums you were paying, but your spouse would be paying for the insurance out of their pay check. So, it is important to do a careful cost benefit analysis of the options. Your employer plan would be the primary insurance for you. When your spouse stops working or you decide to leave the employer coverage, you could again apply for Medicare Part B and then add other coverage as appropriate for your situation at that time.

If the employer group is less than 20 employees, I would NOT recommend dropping your Medicare Part B and your Medicare Advantage Plan because the employer coverage would be secondary to your Medicare coverage and you would NOT be adequately covered.

If you have Medicare due to a disability (not yet 65) the rules change regarding the size of the employer group. The employer group needs to be 100 employees for Medicare to be secondary when someone is on Medicare and younger than 65. So look at the size of the group carefully.

When evaluating the Prescription Drug Benefit of your spouse’s plan it is important to determine if the Part D benefit is considered ‘Creditable Coverage”. This is a definition that is determined by the carrier and the employer, and each employee must be informed of this in writing each year. If the employer coverage is considered ‘Creditable Coverage’, you would be allowed to drop your current prescription drug coverage and enroll into the employer plan without a penalty later. If the employer plan is NOT considered ‘Creditable Coverage’ I would NOT recommend enrolling into the employer insurance. You would not have adequate coverage, plus you would be accruing a penalty for the time without ‘Creditable Coverage’.

Once you are eligible for that new employer coverage and you have determined it meets the criteria allowing you to enroll and still be adequately covered, you have two steps. The first is to call your Medicare Advantage Plan to cancel the coverage. You could also call Medicare (1-800-633-4227) and asked to be dis-enrolled from your Medicare Advantage plan. This situation would qualify for a Special Enrollment Period (SEP). That SEP allows you to dis-enroll from your insurance coverage without a penalty in the future (if you want to re-enroll at a later date).

This cancellation will always cancel the coverage on first of the following month; you cannot cancel the coverage retroactively.

The process to cancel your Medicare Part B coverage, is a little more involved. You must reach out to the Social Security Administration and speak with a representative to cancel your Medicare Part B. You will likely need an appointment to cancel this coverage. The SSA staff will ask a series of questions to clarify your situation and be sure that cancelation of your Medicare Part B is the appropriate decision and will not penalize you later when you need to reenroll into Medicare coverage.

I hope this helps you to make your decision on enrolling into your spouse’s newly available group health coverage. To sum it up, the important questions for you will be: What is the size of the new employer group of your spouse? What is the cost of the coverage when compared to the Medicare coverage you have now? Is the Part D benefit considered ‘Creditable’? The answers to those questions will help you to make your decision.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.