If you’re not planning to retire anytime soon but you’re about to turn 65, you might be wondering if you should sign up for Medicare. Everyone’s circumstances are different, but in general, the decision to enroll will depend on the size of your employer and the value you’re getting from your workplace health insurance.

Key Takeaways

  • Most people will want to enroll in Medicare Part A no matter what, because most people can get it without paying any premiums.
  • You need to find out if your workplace health insurance meets the IRS definition of group coverage and if its prescription benefits count as creditable coverage.
  • If not—or if you work for a company with fewer than 20 employees—you will probably want to enroll in Medicare Part B and Part D to make sure your doctor’s visits and prescriptions are covered and so you don’t have to pay Medicare premium penalties later.

Signing Up for Medicare Part A at 65 If You’re Still Working

If you’re still working at age 65 and you’re not claiming Social Security benefits, the government will not automatically enroll you in Medicare Part A, which covers hospital stays.

If you work for a company with 20 or more employees and you’re enrolled in your employer’s health insurance plan, you do not have to enroll in Part A. If your employer covers the bulk of your premiums, you have a low deductible, and you’re not eligible for premium-free Part A, it might make sense to continue relying solely on your workplace coverage.

If you’re eligible for premium-free Part A—most people are because they’ve paid Medicare taxes throughout their working years—you might as well enroll: You’ve earned it. As secondary health insurance, Part A may cover hospital expenses your employer's plan does not.

If you work for a company with fewer than 20 employees, you should enroll in Part A as soon as you’re eligible. Medicare will become your primary payer.

If you’re covered by a health insurance marketplace plan or COBRA, you should sign up for Medicare Part A during your initial enrollment period, which starts three months before you turn 65, includes your birthday month, and ends three months after you turn 65. 

Note that Part A premium penalties apply if you are not eligible for premium-free Part A and you don’t enroll when you’re first eligible.

Signing Up for Medicare Part B at 65 If You’re Still Working

If you’re still working at age 65 and you’re not claiming Social Security benefits, the government will not automatically enroll you in Medicare Part B, which covers doctor’s visits, diagnostic tests, medical equipment, ambulance transportation, and mental health care.

If you work for a company with 20 or more employees and you’re enrolled in your employer’s health insurance plan, you don’t have to enroll in Part B. You also might not want to because it isn’t free. For 2020, the monthly premium is about $145 ($148.50 in 2021) if you earn up to $87,000 as a single income tax filer or $174,000 as a married filer ($88,000/$176,000 for 2021). Premiums increase in tiers at higher income levels.

However, you need to be sure that your workplace health insurance meets the IRS definition of group coverage. You’ll want to get the answer in writing from your employer. If it doesn’t, you should enroll in Part B to avoid paying the premium penalty that’s imposed if you don’t enroll in Part B within eight months of becoming eligible for it.

If you work for a company with fewer than 20 employees, you should enroll in Part B as soon as you’re eligible. Medicare will become your primary payer.

If you already have Part B but you don’t need it because you have group coverage, you can contact Medicare to unenroll. Keep your proof of group coverage in case you later need to prove you don’t owe a penalty.

If you’re covered by a marketplace plan, a private plan, or COBRA, you should sign up for Medicare Part B during your initial enrollment period to avoid penalties.

You cannot contribute to a health savings account once you enroll in Medicare.

Signing Up for Medicare Part D at 65 If You’re Still Working

To make sure you have prescription medication coverage, you need either creditable prescription drug coverage from work, Medicare Part D, or a Medicare Advantage plan with drug coverage.  Your employer can tell you if your workplace coverage is creditable, meaning it’s as good as or better than Part D.

Once you sign up for Part D, you could lose your workplace prescription coverage and you may not be able to get it back.

If you don’t have either and you don’t enroll in Part D on time, you’ll pay higher Part D premiums.

The Bottom Line

You won’t be automatically enrolled in Medicare at age 65 unless you’re claiming Social Security benefits. But if you’re not retired yet, you may not be claiming those benefits, and you’ll need to proactively choose which parts of Medicare to enroll in and when.

Since Part A is free for most people who have paid Medicare taxes throughout their working years, it usually makes sense to enroll even if you have great health insurance through work. The decision to enroll in Parts B and D is less straightforward, and you’ll need to know if your workplace insurance meets certain requirements before you proceed.