Working Past 65? What to Know About Medicare Enrollment

Turning 65 doesn’t always mean you must enroll in Medicare right away. If you’re still working or covered by an employer plan, the rules can be confusing and mistakes can be costly. Below, we answer common questions about delaying Medicare, coordinating it with employer insurance, and enrolling at the right time to avoid penalties and coverage gaps.

<1> Is Medicare required for everyone who turns 65? I turn 65, but I am still working and have employer health insurance.

Medicare is not automatically required just because you turn 65. Whether you should enroll depends mainly on your employer size and whether your coverage is active and creditable.

• If you work for an employer with 20 or more employees, your employer plan usually pays first. You can often delay Part B and Part D without penalty if your coverage is creditable. Many people still enroll in premium-free Part A at 65, but if you or your spouse contribute to a Health Savings Account (HSA), you may want to delay Part A as well.

• If you work for an employer with fewer than 20 employees, Medicare generally becomes the primary payer at 65. That means you usually should enroll in both Part A and Part B when first eligible. If you don’t, your employer plan may pay as if Medicare already paid or may refuse to pay the portion Medicare should have covered. As a result, you could face unexpected out-of-pocket bills, coverage gaps, and potential late enrollment penalties.

  
  

In some cases, employer coverage may cost more than Medicare. Before deciding whether to delay Medicare or keep employer coverage, compare premiums, out-of-pocket costs, provider networks, and prescription drug coverage to determine which option best fits your needs.

Always confirm your employer size and whether your coverage is creditable with your HR or benefits office before delaying Medicare.

<2> I’m planning to retire soon and haven’t enrolled in Medicare yet because I’ve had employer health insurance. What steps do I need to take to enroll in Medicare now and avoid any late enrollment penalties?

At retirement, you apply for Medicare through Social Security using online, phone, in-person, mail, or fax options. If you’ve had creditable coverage through active employment, you generally qualify for a Special Enrollment Period (SEP), which allows you to enroll in Medicare without late penalties. Enrolling before your employer coverage ends helps prevent gaps.

Part A: You can enroll in premium-free Part A once you are eligible, through Social Security using online Medicare application (SSA system), phone, or In-person at the SSA office, without a penalty. No separate Part A form is required. If you must pay for Part A, you must apply during specific windows (such as your Initial Enrollment Period, General Enrollment Period, or a Special Enrollment Period, if eligible), using Form CMS-18-F-5 as applicable. If you have an HSA, you must stop contributions before Part A becomes effective because Medicare enrollment affects HSA eligibility.

Part B: You must submit these two forms:

• Form CMS-40B (Medicare Part B application)

• Form CMS-L564 (Employer verification of creditable coverage)

In the CMS-40B Section 2, fill out "Choose your coverage start date." Submit both forms to Social Security. This process establishes your Special Enrollment Period (SEP) for Part B and it lasts up to 8 months after your employment or coverage ends.

Part D (if applicable): If your employer drug coverage was creditable, you can enroll in Part D within 63 days of losing employer coverage with no penalty. Medicare only allows a gap of up to 63 days without creditable drug coverage. You can enroll through Medicare.gov or directly with a Part D plan.

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If you have questions about public benefits, there are 3 ways you can reach us today:

Call our Helpline at: (English) 1-800-336-2722, (Korean) 1-800-582-4259,

        (Chinese Mandarin) 1-800-683-7427, (Cantonese) 1-800-582-4218,

        (Vietnamese) 1-800-582-4336

Email: askNAPCA@napca.org

Mail: NAPCA Helpline, 1511 3rd Avenue, Suite 914, Seattle, WA 98101

The National Asian Pacific Center on Aging (NAPCA) is dedicated to improving the quality of life for AANHPI older adults by advocating for their unique needs and ensuring access to culturally competent services.