Does an Employer Have to Offer Health Coverage If I Already Have Medicare?

The law requires employers with over 20 employees to offer health coverage to all full time employees regardless of their age. Thus, they must offer coverage to an employee on Medicare.

An employee meanwhile can do any of the following:

1. Decline the employer health plan.
2. Accept the employer health plan and utilize both health plans (using Medicare as a secondary coverage)
3. Or, if they don't already have Medicare, accept the employer health plan and delay Medicare enrollment.

With that said, the fee for not complying with the employer mandate to offer coverage is levied only when an employee gets marketplace assistance, and since employees with Medicare can't get marketplace assistance, there is a reduced risk here for the employer.

Still, as per the ACA and related healthcare rules, employers must offer coverage regardless of age or Medicare status, and meanwhile the employee has choices.

https://www.aarp.org/health/medicare-qa-tool/do-i-enroll-in-medicare-age-65-even-if-still-working/

NOTE: Health benefits are generally offered as part of employee compensation, and employers have flexibility as to whether they compensate employees who opt out of a health plan. On the employee end, declining an employer health plan could mean missing out on compensation related to the employer offered health plan.

NOTE: Employers technically only have to cover substantially all full time employees (95%). Employers also have to offer dependent coverage. In simple terms, there is more than one thing to think about when considering employer health coverage under the ACA. For more reading on the employer mandate, see  https://obamacarefacts.com/obamacare-employer-mandate/