Working Past 65
Still Working at 65? You May Have a Choice.
Turning 65 doesn’t necessarily mean you have to leave your employer health insurance and enroll in Medicare.
If you’re still working — or you’re covered through a spouse who is still working — you may have two options:
Option 1: Enroll in Medicare
Or
Option 2: Defer Medicare and remain on your employer health plan
The first thing we need to determine is whether you can defer Medicare.
Then we can answer the more important question:
Should you?
Option 1: Enroll in Medicare at 65
Your first option is to enroll in Medicare when you become eligible.
That generally means enrolling in:
Medicare Part A — Hospital Coverage
and
Medicare Part B — Medical Coverage
Once you’re enrolled in Medicare, we can evaluate how you want to cover the expenses that Original Medicare leaves behind.
Depending on your situation, that could mean:
Original Medicare + Medicare Supplement + Part D
Or
Medicare Advantage
At that point, Medicare becomes the foundation of your health insurance instead of your employer plan.
Option 2: Defer Medicare
If you have qualifying group health insurance based on your current employment or your spouse’s current employment, you may be able to delay Medicare Part B without a late-enrollment penalty.
This is very common for people who continue working past 65.
You continue using your employer health plan just as you did before turning 65 and enroll in Medicare later when you retire or lose that employer coverage.
But don’t automatically assume you can defer Medicare simply because you have health insurance through work.
Employer Size Matters
If your employer has 20 or more employees, the employer group health plan generally pays first and Medicare pays second. You may be able to defer Part B while you’re actively working and covered by that plan.
If your employer has fewer than 20 employees, Medicare generally pays first once you’re eligible. In that situation, you need to speak with your employer or benefits administrator about enrolling in Medicare because the employer plan may not pay properly if you don’t have Medicare.
That’s why we always want to understand exactly what type of employer coverage you have before recommending that you defer Medicare.
What About Medicare Part A?
Because most people qualify for premium-free Medicare Part A, you may wonder:
"Why wouldn't I just enroll in Part A and delay Part B?"
For many people, that can make sense.
But there’s an important exception.
Do You Have an HSA?
If you or your employer are contributing to a Health Savings Account (HSA), Medicare enrollment requires additional planning.
Once you’re enrolled in Medicare, you can no longer make HSA contributions.
And if you enroll in premium-free Part A after age 65, Part A can generally be retroactive for up to six months, but not earlier than the month you became eligible.
That means you should coordinate the timing of your Medicare enrollment and HSA contributions carefully to avoid potential tax issues.
What Happens When I Eventually Retire?
If you’ve properly delayed Part B because you had qualifying employer group coverage based on current employment, you don’t have to wait for Medicare’s regular enrollment period when you retire.
You generally receive a Special Enrollment Period.
You can enroll in Part B while you’re still working and covered by the employer plan, or generally within 8 months after the employment or employer coverage ends, whichever happens first.
But we don’t recommend waiting eight months.
The Goal Is a Seamless Transition.
If your employer insurance ends June 30, we want your Medicare coverage and any additional coverage properly coordinated so that your new coverage begins July 1.
- No gap in coverage.
- No unnecessary overlap.
- No last-minute surprises.
COBRA Is Different
This is an important distinction.
COBRA is not considered active employer coverage for purposes of delaying Medicare Part B.
Your Medicare Special Enrollment Period is tied to current employment and the group health coverage associated with that employment.
Choosing COBRA doesn’t restart or extend your eight-month Medicare enrollment window.
This is one of the reasons we recommend talking with us before you retire or leave your employer coverage, rather than waiting until your COBRA coverage ends.
Now Let's Answer the Bigger Question
Should I Stay With My Employer Plan or Enroll in Medicare?
Just because you can stay on your employer plan doesn’t necessarily mean you should.
This is where we think the conversation becomes much more useful.
We compare the two options.
Stay With Your Employer
What are you currently paying for your employer health insurance?
What is your deductible?
What are your copays?
What is your maximum out-of-pocket exposure?
What does your prescription coverage look like?
Are you covering a spouse or children who still need the employer plan?
Does your employer contribute toward your premium or HSA?
Move to Medicare
What will Medicare Part B cost you?
Will you be subject to an income-related Medicare adjustment known as IRMAA?
What would a Medicare Supplement cost?
What would your Part D prescription plan cost?
Or, if you’re considering Medicare Advantage, what plans are available where you live?
Most importantly:
What would your total cost and financial exposure look like under each option?
Let's Compare the Numbers
We don’t believe you should make this decision based simply on someone saying:
“You’re 65. It’s time to go on Medicare.”
Sometimes staying with your employer is the better choice.
Sometimes moving to Medicare can provide better coverage, lower costs or significantly reduce your financial exposure.
The only way to know is to compare them.
Employer Coverage
- Monthly Premium
- Deductible
- Copays / Coinsurance
- Maximum Out-of-Pocket Exposure
- Prescription Costs versus
Medicare
- Part B Premium
- Medicare Supplement or Medicare Advantage
- Part D, if needed
- Expected Out-of-Pocket Exposure
Now we’re comparing the actual options rather than guessing.
Don't Forget About Your Family
This can be one of the biggest factors in the decision.
Maybe you’re turning 65 but your spouse isn’t Medicare eligible yet.
Maybe you still have children covered under your employer plan.
Leaving the employer plan could affect what they pay for health insurance.
Or it may be possible for you to move to Medicare while your spouse and dependents remain on the employer plan.
That’s why this isn’t simply a Medicare decision.
It’s a household health insurance decision.
Our Approach
When you’re working past 65, we help you answer two questions in order.
First: Can You Defer Medicare?
We look at:Part A primarily helps cover:
- Your employment status
- Your spouse's employment status
- Employer size
- Type of group coverage
- HSA considerations
- When you expect to retire
- Then we determine whether delaying Medicare is appropriate.
Second: Should You Defer Medicare?
That’s where we compare:
Your employer coverage
- versus
- Your Medicare options
We look at premiums, deductibles, prescriptions, provider access and your potential financial exposure.
Then you can make an informed decision.
Working Past 65 Doesn't Have to Be Complicated
The question isn’t simply:
"Do I have to enroll in Medicare at 65?"
There are really two questions:
"Can I defer Medicare?"
and then:
"Does it make financial sense for me to defer Medicare?"
Those are two very different questions.
Working Past 65?
Before enrolling in Medicare — or deciding to delay it — let’s compare your options.