How to Choose a Medicare Plan if You’re Still Working After 65

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Turning 65 is an exciting milestone, but it can also bring a lot of questions about your healthcare coverage, especially if you’re still working. Many people wonder whether they should sign up for Medicare if they already have employer-provided health insurance or if they need to take any special steps. The good news is that you don’t have to navigate this decision alone—understanding how Medicare works in conjunction with your employer’s insurance is key.
In this blog post, we’ll break down the essential points of choosing the right Medicare plan while you’re still working, so you can make an informed decision without disrupting your current healthcare.
Step 1: Understand the Basics of MedicareMedicare is a federal health insurance program primarily for individuals age 65 and older, and it consists of four parts:

• Part A: Hospital insurance, which covers inpatient care, skilled nursing facility care, hospice care, and some home health care.
• Part B: Medical insurance, covering outpatient care like doctor visits, lab tests, and preventive services.
• Part C (Medicare Advantage): A private insurance plan that bundles both Part A and Part B, often with added benefits like prescription drug coverage, vision, and dental.
• Part D: Prescription drug coverage that helps pay for medication costs.

If you’re working after 65, you may still be eligible for Medicare, and depending on whether you’re enrolled in your employer’s insurance plan, you may need to take different actions.

Step 2: Know the Rules About Medicare Enrollment While Still EmployedThe rules about enrolling in Medicare when you’re still working are different from when you’re retired. Let’s break it down:

• If you have Employer-Sponsored Health Insurance: If you’re covered under your employer’s insurance, either through your own work or through a spouse’s coverage, you can delay enrolling in Medicare Part B without facing late enrollment penalties. However, you must be covered by insurance that provides at least equal coverage to Medicare. For example, if you work for a company with 20 or more employees, your employer’s insurance can act as primary coverage, and Medicare will be secondary.
  
• Medicare Part A: You’re automatically eligible for Part A at age 65, and most people don’t have to pay a premium for it. Even if you’re still working and covered by your employer’s insurance, it’s often a good idea to enroll in Part A because it covers hospital stays.
  

Step 3: Consider How Your Employer Coverage Works with MedicareIf you're still working and have employer-sponsored health insurance, it's important to understand how that coverage works with Medicare. Here's how the coordination of benefits works:

• If Your Employer Has 20 or More Employees: Your employer’s insurance is considered primary coverage, and Medicare is secondary. This means your employer's plan pays first, and Medicare will pay second, picking up what your primary insurance doesn’t cover. In this case, you may decide to delay enrolling in Medicare Part B, which has a monthly premium.
  
• If Your Employer Has Fewer than 20 Employees: If your employer has fewer than 20 employees, Medicare becomes the primary insurance, and your employer’s plan is secondary. In this case, you may want to enroll in Medicare when you turn 65 to ensure you have adequate coverage, especially for hospital and outpatient services.
  

Step 4: Decide Whether to Enroll in Medicare Part A and Part BYou’re automatically enrolled in Part A when you turn 65 if you’re already receiving Social Security benefits. But if you’re still working, you can choose whether or not to enroll in Part B, which covers outpatient care, such as doctor visits, lab tests, and other medical services.

• If you delay Part B enrollment, you won’t face a penalty as long as you’re covered by your employer's health plan that is at least as comprehensive as Medicare. However, if you don’t sign up for Part B when your employment ends or when you lose your group coverage, you could face penalties if you want to enroll later.
  
• If you opt for Medicare Part B, it will cover outpatient services and may save you money in the long run if your employer coverage doesn’t cover certain medical expenses.
  

Step 5: Understand Your Prescription Drug CoverageIf you are still working and have employer-sponsored insurance, you may have prescription drug coverage through your employer. When considering whether to enroll in Medicare Part D (prescription drug coverage), you’ll need to assess whether your employer’s plan provides enough coverage.

• If Your Employer’s Plan Includes Prescription Drug Coverage: If you’re happy with your employer’s prescription coverage and it is at least as good as Medicare Part D (called creditable drug coverage), you may not need to enroll in Medicare Part D. However, if your employer’s prescription coverage isn’t as robust, you may want to consider enrolling in Part D to avoid future penalties.
  
• If Your Employer Doesn’t Offer Prescription Drug Coverage: In this case, you should enroll in Medicare Part D as soon as you’re eligible. If you don’t, you’ll face penalties when you do decide to enroll.
  

Step 6: Evaluate Your Current Coverage and Compare PlansAt age 65, it’s a good idea to evaluate your existing coverage and compare it to what Medicare offers. Sometimes, Medicare can be more affordable or offer better coverage than employer-sponsored plans. Here are some points to think about:

• Out-of-Pocket Costs: Check how much your employer health insurance costs in terms of premiums, co-pays, and deductibles. Compare that to what you’d pay for Medicare, especially if you add on a Medicare Supplement (Medigap) policy to help cover out-of-pocket costs.
  
• Health Benefits: Review your current plan’s coverage against what Medicare offers. Some employer plans have limits on coverage for services like dental or vision, which Medicare may not cover, but Medicare Advantage plans often include these benefits.
  

Step 7: Enroll in Medicare at the Right TimeYou’ll need to sign up for Medicare during your Initial Enrollment Period (IEP), which begins three months before you turn 65, includes the month of your birthday, and ends three months after your 65th birthday. If you’re still working and have employer coverage, you can delay enrolling in Medicare without penalties, but you must sign up during the Special Enrollment Period (SEP) when your employment ends or when you lose coverage. Failing to enroll during these periods could result in late enrollment penalties.

Step 8: Consider Medicare Advantage Plans (Part C)If you're still working and have employer coverage, you might want to explore Medicare Advantage Plans (Part C). These plans are offered by private insurance companies and cover everything in Part A and Part B but may also include additional benefits like prescription drugs, dental, and vision care.
If you’re still employed but thinking about getting additional coverage, a Medicare Advantage plan could be a smart option, especially if you’re looking for broader healthcare benefits or want to reduce out-of-pocket costs.

Step 9: Get Help with the DecisionChoosing a Medicare plan while still working can feel overwhelming, but you don’t have to make the decision alone. We offer a free Medicare webinar to explain your options in detail and answer any questions you might have. Visit www.simplemedicareclass.com to sign up and learn more.
If you're unsure about which plan is right for you or need assistance understanding the options, we’re here to help.
ConclusionChoosing the right Medicare plan while you're still working requires understanding how Medicare works with your employer coverage. If you're working for a large employer, you may be able to delay enrolling in Medicare without facing penalties, while still keeping your employer insurance as your primary coverage. However, if you work for a smaller company or your employer’s plan doesn’t offer adequate coverage, enrolling in Medicare as soon as you’re eligible is a smart move.
Don’t forget to check prescription drug coverage, and explore Medicare Advantage if you’re seeking additional benefits. If you need more guidance, feel free to call us at +1-888-394-0149 or visit www.simplemedicareclass.com to attend our free webinar.