People who work and pay Medicare taxes for at least 10 years in the United States become eligible for Medicare insurance when they reach the age of 65. While millions of people sign up for Medicare right away at 65, there are many others who don’t. Those that choose not to enroll right away are likely to be working, have insurance coverage through their employers, and aren’t receiving their Social Security retirement benefits yet. 

Deciding whether to enroll in Medicare at 65 is a personal choice but delaying your enrollment can mean paying higher premiums. Those who have health care insurance plans that are comparable to Medicare have some leeway, but it can get complicated. This article can help you figure out whether you should sign up for Medicare if you’re working past 65. 

Medicare enrollment at age 65

If you are receiving Social Security retirement benefits when you turn 65, you’ll be automatically enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance). After automatic enrollment, you have the option to change your coverage from Original Medicare to Medicare Advantage,. You can enroll in prescription drug coverage through Medicare Part D. If you choose Original Medicare, you also have the option of  purchasing a Medigap, or Medicare Supplement, plan. 

Those who aren’t receiving Social Security retirement benefits when they turn 65 can enroll in Medicare on their own during their Initial Enrollment Period. This is a seven-month period that begins three months before their 65th birthday and ends three months after the month of their 65th birthday. 

Medicare advises people who don’t have comparable health care insurance when they turn 65 to enroll in either Original Medicare Parts A and B or Medicare Advantage (Part C) during their Initial Enrollment Period. Doing this assures that they avoid penalties that could increase their Medicare costs during their retirement years. 

If you don’t sign up for Medicare on time, you may incur a ten percent surcharge on Medicare Part B monthly premiums for each one-year period you were without coverage after becoming eligible. In most cases, Medicare Part A doesn’t have a late enrollment penalty because it is premium-free coverage for most people.  

Medicare enrollment after age 65

If you’re still working when you turn 65, you don’t need to enroll in Medicare if you are a beneficiary of a health care plan provided by an employer who has at least 20 employees. If there are less than 20 employees, you should enroll in Medicare at 65 whether you continue working or not. The same is true if you are covered by your spouse’s insurance plan through your spouse’s employer. 

Even if the above is true and you have the health care coverage you need, it might be a good idea to enroll in Medicare Part A when you are first eligible. Even if you have comparable coverage through another policy, Medicare Part A can pay for services that your primary insurance plan doesn’t cover. For most beneficiaries, Medicare Part A is premium-free, so you won’t have out-of-pocket costs for this coverage. 

It’s important to note that if you are paying into a health savings account (HSA) you can’t enroll in Medicare and continue contributing to your HSA.  

Enrolling in Medicare during a Special Enrollment Period

If you decide to delay enrollment in Medicare Part B (or Part C) beyond your 65th birthday because you have comparable health care insurance, you will be eligible for a Special Enrollment Period later. When you retire or leave your group health coverage, Medicare gives you a special eight-month enrollment period to sign up for Medicare. This Special Enrollment Period is also available if you’ve had coverage through your spouse’s employer’s insurance plan. 

If you have coverage through COBRA you should enroll in Medicare when you turn 65 to ensure that you have no coverage gaps or late enrollment penalties. This is because COBRA beneficiaries don’t have access to special enrollment periods and must sign up during the general enrollment period if not during their initial enrollment periods. 

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Retiring at 70? Understanding Your Medicare Benefits(Opens in a new browser tab)