Turning 65 and Still Working? Here’s What You Need to Know About Medicare

If you’re turning 65 and still working, one of the biggest questions you’ll face is:

Do I need to enroll in Medicare?

The answer depends on your employer health coverage and your individual situation. Some people should enroll in Medicare when they become eligible at age 65, while others may be able to delay certain parts of Medicare until they retire or lose their employer health insurance. Understanding your options before making a decision can help you avoid late enrollment penalties and unexpected gaps in coverage.

Quick Summary

If you’re still working when you turn 65:

• You may be able to delay certain parts of Medicare if you have qualifying employer health coverage.
• You may qualify for a Special Enrollment Period when your employment or employer health coverage ends.
• Your employer size and health coverage matter, so don’t assume the same rules apply to everyone.

If you’re unsure what applies to your situation, it’s important to understand your options before your Medicare enrollment deadline.

What Is Medicare?

Medicare is the federal health insurance program for people age 65 and older, as well as certain younger individuals with qualifying disabilities or medical conditions. Medicare is made up of different parts:

• Medicare Part A (Hospital Insurance) helps cover inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
• Medicare Part B (Medical Insurance) helps cover doctor visits, outpatient care, preventive services, durable medical equipment, and many other medical services.

Together, Part A and Part B are commonly called Original Medicare.

Do You Have to Enroll in Medicare at Age 65?

Not always. Many people continue working after turning 65 and receive health insurance through their employer or their spouse’s current employer. Depending on your employer health coverage and your individual circumstances, you may be able to delay enrolling in Medicare Part B (Medical Insurance) without paying a late enrollment penalty, if you’re eligible to delay enrollment under Medicare rules. Because every situation is different, it’s important to understand how your employer coverage works with Medicare before deciding to delay enrollment.

What If You Have Health Insurance Through Your Employer?

If you’re covered by an employer group health plan based on current employment, you may not need to enroll in every part of Medicare right away. If you’re eligible, Medicare provides a Special Enrollment Period when your employment ends or when your employer group health coverage based on current employment ends—whichever happens first. A Special Enrollment Period allows eligible individuals to enroll in Medicare outside of the standard enrollment periods without paying a late enrollment penalty. Whether you qualify depends on your employer coverage and your individual circumstances.

Should You Enroll in Medicare Part A?

Many people choose to enroll in Medicare Part A (Hospital Insurance) when they become eligible because most people don’t pay a monthly premium for Part A if they worked and paid Medicare taxes for at least 10 years. However, if you contribute to a Health Savings Account (HSA), enrolling in any part of Medicare generally means you can no longer make new HSA contributions. If you currently contribute to an HSA—or your employer contributes on your behalf—it’s important to understand how Medicare enrollment may affect your account before signing up.

Does the Size of Your Employer Matter?

Yes. For many employers with fewer than 20 employees, Medicare generally becomes the primary payer once you’re eligible for Medicare. However, employer health plans can vary, so it’s important to confirm how your specific coverage works before deciding to delay Medicare enrollment. Your employer’s benefits administrator can help explain how your health plan coordinates with Medicare.

Questions to Ask Before Delaying Medicare

Before deciding whether to enroll, consider asking:

• Does my employer health coverage allow me to delay Medicare Part B?
• Who pays first—my employer health plan or Medicare?
• Should I enroll in Medicare Part A?
• How will Medicare affect my Health Savings Account (HSA)?
• What happens when I retire?
• Will I qualify for a Special Enrollment Period?

Understanding the answers to these questions can help you avoid costly mistakes and make informed decisions about your healthcare coverage.

The Bottom Line

Turning 65 doesn’t automatically mean you need to enroll in every part of Medicare. If you’re still working and have employer health insurance, you may have options. The right decision depends on your employer coverage, your employment status, and your individual circumstances. Before delaying Medicare, take the time to understand how your current health insurance works with Medicare and what enrollment rules apply to your situation. Making an informed decision today can help you avoid unnecessary penalties, prevent gaps in coverage, and give you confidence about your Medicare choices.