Of course, turning 65 doesn’t mean you have to retire—but it does mean Medicare eligibility begins, and many people still wonder:

“If I’m still working and have health insurance through my employer, do I need to enroll in Medicare when I turn 65?”

The answer depends on several factors—including your employer size, your current health coverage, and whether you’ve already started Social Security. At Emerald Medicare, we help clients evaluate these decisions every day to avoid penalties, gaps, or unnecessary costs.

Let’s break it down…

✅ Start with Medicare Part A: Most People Enroll

Medicare Part A (hospital insurance) is premium-free for most people and generally covers inpatient hospital stays, skilled nursing, and hospice care.

• If your employer has coverage and you’re still working, you can usually enroll in Part A at 65 without any downside.
• HOWEVER—if you’re contributing to a Health Savings Account (HSA), you may want to delay Part A to avoid tax issues.

🧾 What About Part B? It Depends on Employer Size

Medicare Part B covers outpatient care, doctor visits, and preventive services. Unlike Part A, you do pay a monthly premium for Part B—so enrolling unnecessarily could cost you.

IF YOUR EMPLOYER HAS 20 OR MORE EMPLOYEES:

• You can delay enrolling in Part B without penalty.
• Your employer coverage remains primary, and Medicare is secondary.
• You’ll qualify for a Special Enrollment Period (SEP) when you retire or lose coverage—no late penalty.

IF YOUR EMPLOYER HAS FEWER THAN 20 EMPLOYEES:

• You must enroll in Medicare Part A and B when first eligible.
• In this case, Medicare becomes your primary insurance, and your employer plan pays second—or not at all.
• Failing to enroll could leave you uninsured and/or penalized.

Always check with your HR department—don’t assume your employer coverage counts as “creditable” for Medicare.

💼 Still Working with an HSA? Be Careful

If you’re contributing to a Health Savings Account (HSA) and you enroll in any part of Medicare, including Part A, you must stop HSA contributions.

• Enrollment in Medicare (even Part A) disqualifies you from contributing.
• Retroactive Part A enrollment (up to 6 months) can create IRS penalties if you’re not careful.
• We typically recommend stopping HSA contributions at least 6 months before you apply for Medicare.

📍 Why It Matters

Making the wrong choice about when to enroll can lead to:

• Late enrollment penalties
• Gaps in coverage
• Unexpected bills if Medicare should have paid primary
• Tax consequences for HSA users

✅ When to Enroll (or Delay) Original Medicare: A Quick Recap

Or, Contact Us
📞 (888) 683-6372 or (845) 358-1220
📧 office@emeraldmedicare.com

As your trusted Medicare resource with Licensed Medicare experts, we know that understanding Medicare eligibility and the enrollment process can often overwhelming or confusing. Whether you’re approaching age of 65 or considering retirement, or navigating Medicare eligibility for yourself or a loved one, this guide will help clarify who qualifies for Medicare and how to navigate the enrollment process.

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Who Qualifies for Medicare?

The most common way to qualify for Medicare is by reaching the age of 65. If you or your spouse have worked and paid Medicare taxes for at least 10 years (40 quarters), you’re eligible for premium-free Medicare Part A (hospital insurance). Medicare Part B (medical insurance) is available for a monthly premium based on your adjusted gross income from your tax return income from 2 years prior.

If you’re under 65 but have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, you automatically qualify for Medicare. You’ll receive Medicare Parts A and B, just like someone who qualifies based on age. Based on the health insurance you have access to currently you may or may not accept Part B at that time.

Individuals of any age with End-Stage Renal Disease (ESRD), requiring regular dialysis or a kidney transplant, qualify for Medicare. Coverage usually starts the first month of dialysis if you apply promptly.

If you have ALS, you automatically qualify for Medicare the first month you start receiving SSDI benefits, with no 24-month waiting period.

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How to Apply for Medicare

Already Receiving Social Security: If you’re already receiving Social Security benefits, you’ll be automatically enrolled in Medicare Parts A and B when you turn 65. Your Medicare card will arrive in the mail about three months before your 65th birthday. Based on your specific situation if you are working or covered through your spouse you may keep your company coverage or consider Medicare options at this time. If you choose to keep the company coverage you would need to reject your Part B so that the premium for Part B does NOT come out of your social security check. This decision is an important one and our suggestion is to consult with an experienced Medicare advisor to guide you properly to your best course of action at this stage.

If you’re not receiving Social Security benefits, you will need to be proactive in signing up for Medicare on your own when the time is right. You can do this through the Social Security Administration (SSA) website, by phone by scheduling an appointment, or in person at your local SSA office. Consult a medicare expert to ensure you avoid timing and/or penalty issues. 

The Initial Enrollment Period is a seven-month window that includes the three months before your 65th birthday, the month of your birthday, and the three months after. This is your first opportunity to sign up for Medicare Parts A and B. This ONLY applies to individuals who are self-employed, unemployed or working for a company of less than 20 employees. This is often a very often misunderstood aspect of Medicare.

If you’re still employed (for a company greater than 20 employees) and covered by an employer’s health plan, you can delay enrolling in Part B without penalty. Once your employment ends, you’ll have an eight-month Special Enrollment Period to sign up for Part B before you would incur a penalty. Each person’s situation is different based on the cost of Cobra for you and your family and the quality and details of coverage your company provides.

Missed Initial Enrollment: If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you can enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, a late enrollment penalty may apply.

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Understanding Medicare Parts A and B

Medicare Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Medicare Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and medical supplies.

Understanding these components is crucial for selecting the right coverage and avoiding potential penalties. To learn more, click below to read our blog post on Medicare Parts A and B. 

Take Charge of Your Medicare Journey with Emerald Medicare

Navigating Medicare eligibility and enrollment can be overwhelming, but you don’t have to do it alone. Our team of Licensed Medicare experts is here to guide you through every step of the process, ensuring you make informed decisions about your healthcare coverage. Click below to schedule an appointment with one of our expert brokers through Calendly, or contact us via the provided phone number or email.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com

At Emerald Medicare, we know how important it is for you to have a clear understanding of your healthcare options. In this post, we’ll break down Medicare Parts A and B — often referred to as “Original Medicare” — to help you make informed decisions about your health coverage.

What is Medicare Part A?

Part A (Hospital Coverage) covers essential services such as inpatient hospital stays, home health care, and skilled nursing facility care. Together with Medicare Part B, these services form the core of Original Medicare.

Q: “Is Medicare Part A free?”

A: Most people don’t pay for Part A if they have paid Medicare taxes (FICA) while working. However, if you don’t qualify for premium-free Part A, it can be purchased for a monthly premium. The exact amount may vary based on how long you or your spouse worked and paid Medicare taxes.

What is Medicare Part B?

Part B (Medical Coverage) is designed to cover doctor visits, outpatient services, X-rays, lab tests, and preventive screenings. It’s a key component of your healthcare, granting you access to a wide array of medical services.

Q: “Do you need Medicare Part B?”

A: Yes and No; If you have health insurance through a current job or your spouse’s employer plan, you can delay your Medicare Part B enrollment without penalty*. Once the employer coverage ends, you have an eight-month window to sign up for Part B. Further, you MUST be enrolled in Medicare Part B if you want to sign up for a Medicare Advantage and/or MediGap plan. Reviewing the costs associated with your employer coverage is essential when making this decision.

*company providing coverage must be greater than 20 employees.

How Do Parts A and B Work Together?

Together, Medicare Parts A and B provide coverage for both hospital and medical care at 80% coverage. While Part A focuses on inpatient care, Part B covers all outpatient services, making them complementary in providing comprehensive healthcare coverage throughout retirement & beyond the age of 65.

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Key Points to Consider

Enrollment

When you’re eligible, you can enroll in both Medicare Parts A and B through the Social Security Administration (SSA). Enrollment for original Medicare is automatic if you’re already receiving Social Security benefits. However, if you are not collecting Social Security, you’ll need to be proactive and sign up either by going online to SSA.gov, In-Person to your local Social Security office, or by calling Social Security for a phone appointment.

Coverage

Original Medicare covers the essentials, but there are services it doesn’t include, such as prescription drugs (covered via Part D), routine dental or vision care, and/or hearing aids. Understanding these gaps is crucial as you consider additional coverage options like Medigap or Medicare Advantage plans.

Costs

While Part A is typically premium-free, Part B comes with a standard monthly premium which can increase based on your income. When you apply for Part B, your income level is calculated using your tax return from 2 years prior. Additionally, depending on your supplemental coverage, you should expect some out-of-pocket costs, such as deductibles, co-pays and coinsurance. The amount will vary depending on the plan you choose.

Emerald Medicare is your Trusted Medicare Resource.

Making the right decisions about your Medicare coverage can be confusing, timely, and/or stressful. If you have questions about Medicare Parts A and B, or need help navigating your options, our team of Licensed Medicare experts is here to assist throughout retirement & beyond.

Contact Us:
Phone: (888) 683-6372 or (845) 358-1220
Email: office@emeraldmedicare.com