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Should I Enroll in Medicare if I’m Still Working?

For most people, Medicare eligibility starts at age 65. As you near this age, you’ll need to make several important decisions about your Medicare coverage. Putting off these decisions can result in lifetime late enrollment penalties.

That said, what happens if you’re still working at 65 and feel you don’t need Medicare? The answer depends on your situation – how long you’ve worked, where you work, what type of insurance you have currently, etc. Take the time to understand what suits your lifestyle the best, and you might find it does make sense to enroll in Medicare while you’re still working.

Skip to the section below that matches your situation the best to learn more – don’t forget to check out the additional considerations at the end!

In this article:

I Have an Employer-Provided Health Insurance PlanJump to
I Have TRICARE, CHAMPA or VA CoverageJump to
I Have a Marketplace or Other Private Health Insurance PlanJump to
I’m Not Currently Enrolled in a Health Insurance Plan Jump to
Additional Considerations to Keep in Mind  Jump to

I Have an Employer-Provided Health Insurance Plan

If you’re currently covered by an employer, whether it’s your own or your spouse’s, you’ll want to consider the size of the employer. If you’re covered by a previous employer, the decision can be a little simpler. 

I have health insurance through my (or my spouse’s) current employer

If you’re still working and are covered through either your or your spouse’s current employer, then your decision will come down to how many people are employed by said employer.

My (or my spouse’s) employer has fewer than 20 employees

You should strongly consider enrolling in Part A and Part B when you turn 65. This is because Medicare will be the primary payer for your health coverage – meaning they would pay before your employer’s group insurance plan.

In many cases, your group plan may refuse to pay claims until Medicare pays its part. To determine if that’s the case, you should speak to the employer providing the health plan. They can help you decide if you need to sign up for Part A and Part B.

Also, Medicare usually does not consider a group health insurance plan from an employer with fewer than 20 employees to be creditable coverage.

This means, if you delay enrolling in Medicare and then lose your employer-provided plan for any reason (like if you decide to quit or retire) you could be charged Part B late enrollment penalties.

These late penalties are for going without creditable coverage while you’re Medicare eligible, and they increase the longer you wait.

My (or my spouse’s) employer has 20 or more employees

If you have coverage through a current employer with 20 or more employees, then you don’t have to enroll in Medicare Parts A and B right away. Medicare considers this to be creditable coverage.

If you have creditable coverage, you can delay your enrollment and use what’s called a Special Enrollment Period (SEP) to join Medicare when you leave your job or your employer stops offering coverage.

NOTE: This only applies to those receiving benefits directly from an employer. If your employer pays for or reimburses you for a private insurance plan, jump to the section titled I Have a Marketplace or Other Private Health Insurance Plan.

That said, if you’re covered directly through an employer, you should still consider enrolling into Part A even if you don’t feel like you need Part B.

In most cases, Part A won’t cost you anything in premiums. It will work as your secondary insurance – covering some hospital and skilled nursing costs that aren’t covered by your employer plan. So, you’ll essentially get extra coverage for free.

Do you contribute to an HSA?

If you contribute to a Health Savings Account (HSA) and want to keep contributing to it, you may want to delay enrolling in Medicare Part A and B. Medicare enrollees are not allowed to contribute to an HSA (even if it’s part of a qualified high-deductible health plan).

I have health insurance through a previous employer

If you have health insurance from a previous employer, including COBRA or retiree health insurance, you’ll most likely want to enroll in Medicare Part A and B during your Initial Enrollment Period (IEP) when you turn 65.

COBRA is not considered creditable coverage by Medicare. This means if you don’t enroll in Medicare during your IEP:

  • You must enroll in Part B within the first 8 months of having COBRA.
  • If you don’t enroll in these 8 months, you will have to wait until the next annual Medicare General Enrollment Period (January 1 – March 31).
  • If you enroll after the first 8 months, you will incur a lifetime Part B late enrollment penalty (which increases the longer you’ve been without creditable coverage).

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I Have TRICARE, CHAMPA or VA Coverage

In most cases, if you have TRICARE or CHAMPA, you’re required to enroll in Medicare Part A and Part B during your Medicare Initial Enrollment Period (IEP).

You can remain eligible for TRICARE without enrolling in Medicare Part B if you are:

  • An active-duty service member
  • An active-duty family member
  • Enrolled in TRICARE Reserve Select, Retired Reserve, Young Adult, or the US Family Health Plan

If Veterans Affairs, or VA is your only coverage, then you should enroll in Medicare when you turn 65 even if you’re still working. VA coverage is not considered to be creditable coverage for Part B. If you don’t enroll in Medicare during your IEP at 65, you’ll have to wait to sign up until the annual Medicare General Enrollment Period (January 1 – March 31). If this delay causes a gap in creditable coverage, you could be responsible for paying a lifetime Part B late enrollment penalty (which increases the longer you wait).

I Have a Marketplace or Other Private Health Insurance Plan

The Health Insurance Marketplace was set up by the Affordable Care Act (aka Obamacare). If you purchased a health plan through there or a private insurer not directly offered by an employer, you’ll most likely want to enroll in Medicare Parts A and B when turning 65 even if you’re still employed.

Marketplace plans are not considered creditable coverage for Medicare. If you wait until after your Initial Enrollment Period at 65, then you could face gaps in creditable coverage and be responsible for paying a lifetime Part B late enrollment penalty (which increases the longer you wait).

NOTE: This also applies to you if your employer gives you money to pay for or reimburses you for a marketplace or private insurance plan.

I’m Not Currently Enrolled in a Health Insurance Plan

If you’re not covered by any health insurance plan, you should enroll in Medicare Parts A and B when you turn 65 even if you’re still working.

In most cases, you won’t have to pay a premium for Part A. If you’re worried about affording your Part B premiums, there may be options available to you. Need help paying your Medicare premiums? Click here. 

Additional Considerations to Keep in Mind

You’ll likely qualify for premium-free Part A and automatic enrollment at 65

In most cases, you’ll automatically be enrolled in Medicare Part A when you turn 65 if you’re eligible for premium-free Part A. Most people pay no premiums for Part A.

You should qualify for premium-free Part A if you:

  • Or your spouse worked at least 10 years (40 quarters) and paid Medicare taxes
  • Are eligible for Social Security or Railroad retirement benefits
  • Have had Medicare-covered government employment

If you’re still working at 65 and considering delaying Medicare enrollment, it’s usually a good idea to at least accept Part A. It will work as your secondary insurance – covering some hospital and skilled nursing costs that aren’t covered by your employer plan. So, you’ll essentially get extra coverage for free.

Avoid enrolling in Medicare and you could end up with gaps in coverage and late penalties

You can begin enrolling in Medicare 3 months before your 65th birthday month. This is called your Initial Enrollment Period (IEP).

If you don’t enroll during your IEP, you can’t just join Medicare whenever you’re ready. You’ll have to either qualify for a Special Enrollment Period (SEP) or wait for the annual General Enrollment Period (January 1 – March 31).

Those still working at 65 who have creditable coverage may delay enrollment and will receive an SEP. This special enrollment period:

  • Begins the first of the month after you separate from your employer
  • Or the first of the month after your group health coverage ends (whichever comes first)
  • And lasts for 8 months

Most others will not receive an SEP and could be faced with gaps in coverage that result in Part B late enrollment penalties.

Take advantage of your resources if you have questions

Making the decision to delay your Medicare enrollment shouldn’t be taken lightly. If you want to be sure you aren’t subjecting yourself to late enrollment penalties, it’s important to have the right answers.

Always start with the employer first when you have questions about how Medicare may or may not work with your current group health insurance plan.

If you’re receiving a health plan from someone other than an employer, speak with the insurance carrier managing the plan. The employer and the insurance carrier can tell you if your plan is a secondary or primary payer to Medicare or if it’s considered creditable coverage for Part B.

You can also reach out to an expert, like an insurance agent or broker who specializes in Medicare products. If you’d like help determining the best move for you, feel free to give us a call to speak with a licensed insurance agent at the number on this page.

Ensurem Trusted Expertise

Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.

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Denise Austin, 65, Ensurem Ambassador

Best-Selling Author, Creator of Fit Over 50 Magazine

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