Do I Need to Sign Up for Medicare If I'm Still Working?
Turning 65 doesn’t automatically mean you need to enroll in Medicare — especially if you’re still employed and have health coverage. Understanding your options can help you avoid unnecessary costs and coverage gaps.
Working at 65: Do You Have to Enroll in Medicare?
If you are still working and have employer-provided health insurance, you might be able to delay enrolling in Medicare Part B (and avoid paying the Part B premium) without penalty.
The rules depend on:
- Employer Size:
- 20 or more employees: You can usually delay enrolling without penalties.
- Fewer than 20 employees: Medicare becomes your primary insurance, and you should enroll when first eligible.
- Type of Coverage: COBRA, retiree coverage, and marketplace plans are not considered “active employer coverage” — you generally must enroll in Medicare to avoid penalties.
👉 Have an HSA? If so, it’s crucial you learn about the rules involving Medicare and HSA’s here!
Should I Still Enroll in Medicare Part A?
Yes — most people should enroll in Medicare Part A (hospital insurance) at 65, even if they’re still working.
- Part A is usually premium-free if you or your spouse paid Medicare taxes for at least 10 years.
- Having Part A can help cover hospital stays and some skilled nursing care.
👉 Need a refresher on Part A? Learn about the four Medicare Parts and what they cover here!
If you plan to retire later:
- You qualify for a Special Enrollment Period (SEP) to sign up for Medicare without penalties.
- SEP typically gives you 8 months after employment or group health coverage ends to enroll.
Penalties for Late Enrollment
If you don’t sign up on time when required, you could face:
- Part B late enrollment penalty: A 10% increase in your premium for each full 12-month period you delay.
- Part D late enrollment penalty: If you go without creditable drug coverage for 63+ days.
Avoiding these penalties starts with knowing whether you need to enroll while working.
Key Takeaways
- If your employer has 20+ employees, you can delay Part B without penalty.
- If your employer has fewer than 20 employees, you should enroll when first eligible.
- Enroll in Part A at 65, unless you’re contributing to an HSA (Health Savings Account).