ICHRA FOR EMPLOYERS AND MEDICARE-ELIGIBLE EMPLOYEES

How can an ICHRA give Medicare-eligible employees better support?

Help employees understand how Medicare fits with the ICHRA without asking HR to interpret coverage, compare plans, or manage each individual decision.

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ICHRA AND MEDICARE

Why does Medicare add complexity to an employee's ICHRA experience?

Employees approaching Medicare eligibility may need to understand enrollment rules, coverage structures, reimbursement questions, and timing requirements. A standard individual-market workflow may not answer those questions.

Exact handles the personal conversation about current coverage, doctors, prescriptions, budget, spouse needs, and available Medicare paths. HR provides the benefit framework and a trusted referral path without becoming the middleman for every decision. Learn more about ICHRA and Medicare services.

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EMPLOYEE MEDICARE SUPPORT

How can employers answer Medicare questions before it becomes urgent?

Early education

Introduce Medicare resources months before eligibility. See Medicare.gov guidance for people working past 65.

Direct scheduling

Give employees a clear way to request help.

Individual review

Discuss the employee's providers, prescriptions, and budget.

Enrollment coordination

Help the employee understand timing and next steps. See how to apply for Medicare Part A and B online.

Ongoing service

Provide a contact after enrollment.

benefits

What ICHRA benefits matter most to employers and employees?

Take Medicare questions off HR's desk

Shift personal plan and coverage questions to licensed Medicare specialists. Estimate your Medicare savings with our calculator.

Help employees make informed decisions

Base the conversation on the employee's real health, financial, and family situation.

Support spouses and dependents

Review family coverage before an employee changes coverage. Learn how Medicare affects under-65 spouses.

Serve real-world employee situations

Support people working past 65, distributed employees, and participants with complex prescriptions.

Coordinate reimbursement-ready steps

Explain what information the ICHRA administrator requires after enrollment. See how ICHRA administrators and platforms coordinate Medicare support.

Give HR a named contact

Create a consistent referral and escalation process for employee questions.

ICHRA BENEFITS

How does the ICHRA decision differ from the employee's Medicare decision?

If an employer replaces group coverage with an ICHRA for an applicable employee class, those employees generally move to individual coverage. The employee still needs clear information to choose the coverage path that fits their circumstances. Review the Department of Labor's Individual Coverage HRA guidance.

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FAQs

What do employers and employees ask about ICHRA and Medicare?

Can Medicare-eligible employees participate in an ICHRA?

They may be able to participate when applicable ICHRA and Medicare requirements are satisfied. The plan administrator and current guidance control the final determination.

Can an ICHRA reimburse Medicare premiums?

Certain Medicare premiums may be eligible when the arrangement is properly designed and the participant meets the requirements. Avoid treating every premium or expense as automatically reimbursable.

Does the employee have to leave the group plan?

If the employer replaces group coverage with an ICHRA for the applicable employee class, those employees generally move from the group plan to individual coverage. The precise treatment depends on the ICHRA design and employee circumstances.

What if the employee's spouse is not Medicare eligible?

Spouse and dependent coverage should be reviewed before the employee changes coverage so the household understands the full impact.

Does this create more work for HR?

The intended model gives HR a consistent referral path and shifts personal Medicare questions to licensed specialists.

Partnerships

Our Medicare Partnerships

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