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

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Choosing the right Medicare Supplement plan can feel overwhelming. With so many options, it’s important to find a balance between affordable monthly costs and reliable coverage when you need it most. While the standard Medicare Supplement Plan G continues to be one of the most popular options, there’s another version that’s gaining attention: the High Deductible Plan G (HD-G).

At Emerald Medicare, our licensed experts help clients every day understand the differences between these plans so you can make the choice that fits both your health and your budget. Here’s what makes the High Deductible Plan G worth considering.

In 2025, the annual deductible for the High Deductible G is $2,800. Once that deductible is met, the plan covers 100% of the same benefits as a traditional Plan G. That includes:

• Medicare Part A coinsurance and hospital costs
• Medicare Part B coinsurance or copayments
• Skilled nursing facility coinsurance
• Part A hospice care coinsurance or copayments
• The Medicare Part A deductible
• Medicare Part B excess charges
• Coverage for foreign travel emergencies (80%, up to plan limits)

Essentially, after you meet the deductible, you enjoy the same comprehensive coverage and peace of mind that has made Plan G so popular.

High Deductible Plan G can be especially appealing if you’re generally healthy and don’t anticipate frequent doctor visits or hospital stays. You’ll save money on your monthly premiums, and while you may have to pay more out of pocket if an unexpected medical event occurs, your maximum yearly costs are capped at the deductible plus your premiums. This balance of affordability and protection makes HD-G an attractive choice for many Medicare recipients.

Just like a standard Plan G, the High Deductible G allows you to see any doctor or hospital in the U.S. that accepts Medicare. There are no networks and no referrals required. That flexibility ensures you can access the care you need, whether you’re close to home or traveling.

One of the challenges with Medicare alone is the potential for unpredictable out-of-pocket expenses. With the High Deductible Plan G, you know exactly what your worst-case scenario costs could be each year: the deductible amount plus your monthly premiums. This predictability gives you financial confidence and helps with budgeting in retirement.

The High Deductible Plan G isn’t the perfect fit for everyone, but for many Medicare recipients, it strikes the right balance of lower monthly premiums and solid financial protection. If you’re healthy, budget-conscious, and want predictable maximum costs, HD-G may be the right choice for your Medicare coverage.

At Emerald Medicare, we specialize in helping you evaluate your options and choose the plan that works best for your unique needs. Our services are always 100% free, and our team is dedicated to making Medicare simple, clear, and stress-free.

Making the right Medicare decision doesn’t have to be confusing. If you’d like to learn more about whether High Deductible Plan G is a good fit for you, we’re here to help.

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At Emerald Medicare, we take pride in building strong partnerships with a wide range of professionals, including Financial Planners, CPAs, and Health Professionals. Our goal is to provide expert Medicare guidance that complements the services these professionals offer, enhancing the value they bring to their clients. Further, these partnerships ensure we’re prepared when our clients need assistance with something besides Medicare; we can confidently connect them with the proper medical and/or financial professional for their needs. By offering education, resources, and hands-on support, we empower firms and medical offices to confidently address the Medicare needs of their clients and patients. Here’s how we work with these allied professionals to deliver outstanding results.

Financial Planners and Wealth Advisors play a critical role in helping clients achieve long-term financial security. Integrating Medicare planning into Wealth Planning services adds immense value and builds client trust. At Emerald Medicare, we collaborate with planners & firms across the country to offer free expert Medicare consultations that complement their financial advice.

• Customized Medicare Education: We provide tailored Medicare education that aligns with the client’s financial goals, helping them understand their options for Medicare Parts A, B, C, and D as well as Medigap plans.
• Annual Coverage Reviews: Our team conducts annual reviews to ensure that clients’ Medicare coverage adapts to changes in their healthcare needs and financial circumstances.
• Hands-On Guidance: Planners can connect us directly with their clients or work with us on behalf of their clients. Either way, we guide each individual through the Medicare enrollment process, ensuring they choose the best plan for their unique situation.
• Unbiased Recommendations: As an independent brokerage, we’re not tied to any specific insurance provider. Our recommendations are based solely on what’s best for the client, offering planners peace of mind.

This collaborative approach not only enhances the value planners provide to their clients but also strengthens client loyalty and satisfaction.

CPAs and Tax Professionals often encounter clients who are approaching Medicare eligibility or are already Medicare beneficiaries. Understanding Medicare’s financial implications, such as premiums, penalties, and tax considerations, is crucial for their clients’ financial well-being. At Emerald Medicare, we partner with CPA firms, large and small, to provide expert Medicare insights that complement their tax and financial services.

• Presentations and Educational Events: We sponsor professional organizations such as state chapters of the Society of Public Accountants (MassCPA, CTCPA, NYCPA, etc.) and the Financial Planning Association (FPA). Through these partnerships, we deliver seminars, webinars, and Lunch & Learn sessions tailored to CPAs and their firms.
• Medicare Guidance for Clients: CPAs can refer their clients to us for one-on-one Medicare consultations. We provide personalized advice that helps clients make informed decisions about their healthcare coverage.
• Streamlining Complexities: We help CPAs understand how Medicare interacts with tax planning, such as the tax-deductibility of premiums and penalties for late enrollment. This knowledge enables CPAs to provide more comprehensive financial advice.
• No-Cost Expertise: Our services are always free, allowing CPAs to enhance their value proposition without adding costs for their clients.

By integrating Medicare education and resources into their practice, CPAs can offer a more holistic service to their clients while benefiting from the expertise of Emerald Medicare.

Health professionals—including doctors, case managers, social workers, and Certified Senior Advisors (CSAs)—are often the first to hear their patients’ or clients’ concerns about Medicare. These professionals play a crucial role in guiding older adults through their healthcare and retirement journey, and Emerald Medicare partners with them to ensure their patients and clients receive the best possible Medicare guidance.

• Collaboration with Medical Offices: We partner with local medical practices to provide Medicare education and resources that help their staff address patient questions confidently.
• Support for Case Managers and Social Workers: Through partnerships with organizations like the Case Management Society of America (CMSA), we offer training sessions and resources tailored to case managers and social workers. This support enables them to guide patients toward informed Medicare decisions.
• Partnerships with Certified Senior Advisors (CSA): As active members and presenters at the Society of Certified Senior Advisors’ national conference, we regularly collaborate with CSAs who guide older adults through complex retirement and aging decisions. By partnering with Emerald Medicare, CSAs gain an experienced ally who can address the Medicare-specific concerns of their clients, ensuring comprehensive support.
• Patient and Client Referrals: Health professionals and senior advisors can refer their patients or clients directly to Emerald Medicare for personalized consultations. We assist each individual in finding plans that meet their medical and financial needs, ensuring a smooth enrollment process.
• Professional Events: By sponsoring and attending events hosted by medical and senior-focused organizations, we build strong professional relationships and provide tools that help allied professionals address Medicare inquiries effectively.

Our collaboration with health professionals, case managers, and senior advisors enhances both patient and client satisfaction while allowing professionals to focus on their core services.

At Emerald Medicare, we believe in the power of collaboration to deliver better outcomes for clients and patients. Whether you’re a Financial Planner, CPA, Health Professional, or Certified Senior Advisor, our expert team is here to support your efforts by providing education, resources, and hands-on guidance tailored to your clients’ and patients’ unique needs. Best of all, our services are always 100% free, making it easy to enhance your value without adding costs.

If you’re interested in partnering with Emerald Medicare, contact us today to learn more about how we can work together. Schedule an appointment with one of our expert brokers through Calendly, or reach out directly using the information below.

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Medicare selected 10 high-cost, widely used drugs for the first round of negotiated price reductions. These medications treat conditions like diabetes, heart disease, arthritis, blood clots, and cancer—diseases that affect millions of Medicare beneficiaries.

These reductions will bring life-changing relief for many Medicare beneficiaries. For example, someone managing diabetes with Jardiance or NovoLog insulin could save hundreds of dollars every month, while cancer and autoimmune patients may see savings in the thousands. Across the country, these negotiated prices are projected to save Medicare $6 billion, with direct out-of-pocket savings for patients estimated at $1.5 billion annually.

This first round of negotiations is part of a larger rollout. More drugs will be added to the program in future years. For example, 15 additional medications have already been selected for negotiation and are expected to see lower costs in 2027. These include treatments for diabetes, obesity, and cancer—some of the fastest-rising costs in Medicare.

It’s also important to note that the $2,000 annual out-of-pocket cap for prescription drugs took effect in 2025. Combined with these new price reductions, Medicare beneficiaries will see some of the most significant financial relief in decades.

• Check Your Medications: If you take one of the drugs on the 2026 negotiated list, prepare for cost savings beginning in January.

• Review Your Plan This Fall: During the Annual Enrollment Period (October 15 – December 7, 2025), plans may adjust formularies and premiums in response to these changes. It’s more important than ever to compare options.

• Plan Ahead for 2027 and Beyond: Even if your current prescriptions aren’t on this first list, future rounds of negotiations could impact your costs in the years ahead.

Drug costs are one of the biggest challenges facing retirees, but these new 2026 changes mark a turning point. At Emerald Medicare, our role is to help you navigate these transitions, understand how your plan may change, and ensure you’re getting the best value available.

If you’re wondering how these price reductions—or the new $2,000 annual cap—will affect your personal coverage, we’re here to help.

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📞 Call us at (888) 683-6372 or (845) 358-1220
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As part of our commitment to keeping you informed, today’s post focuses on a newly passed bill that could reshape Medicaid and Affordable Care Act (ACA) coverage over the next decade. While you may have seen some recent headlines about health care cuts, most of the actual changes won’t take effect until 2026.

President Trump’s recent tax and spending bill includes nearly $1 trillion in reductions to federal health programs, especially Medicaid. However, these cuts are phased in over the next 9 years, meaning many of the changes won’t be felt right away. This delayed rollout is significant—it avoids immediate disruption, but also makes it harder for families to recognize what’s coming down the road.

• • • Work Requirements: Up to 12 million people could eventually lose coverage due to new work rules, which will begin to be enforced sometime in 2026.
    • Eligibility Checks: Starting December 31, 2026, recipients will face eligibility reviews every 6 months.
    • New Cost Sharing: As of October 2028, those covered under Medicaid expansion could face up to $35 per service.
    • State-Level Funding Cuts: Medicaid provider tax relief begins to phase down in 2028, potentially impacting hospital funding and services.

• • • Enhanced Subsidies Expire Soon: ACA marketplace plans will become more expensive—premium subsidies end Jan. 1, 2026, which could cause premiums to rise over 75%.
    • Planned Parenthood Cuts: Federal Medicaid funding will stop next year, with up to 200 clinics at risk of closure.
    • Immigrant Eligibility Restrictions: Changes limiting Medicaid access for lawfully residing immigrants take effect October 2026.

Even though most changes are delayed, some hospitals and clinics are already reacting. For example, Community Hospital in McCook, Nebraska, recently announced it will close due to Medicaid uncertainty.

Lawmakers and advocacy groups are expected to push back or delay some provisions before they take effect. In the meantime, both political parties are using the bill as a talking point—so expect to hear more in the coming months.

At Emerald Medicare, we’re keeping a close eye on these developments so you don’t have to. While nothing changes today, understanding the long-term outlook helps you plan wisely and stay protected.

If you have questions about how these changes may affect your situation in the future, we’re here to help.

At Emerald Medicare, we’re committed to empowering our clients with the knowledge they need to make informed decisions about their healthcare. Hearing care is a critical – yet often overlooked – aspect of overall health, and we believe the topic deserves special attention. To shed light on the subject, we had the pleasure of speaking with Dr. Kathleen Wallace, Au.D., from Anywhere Audiology. Dr. Wallace is a well-respected and innovative audiologist with years of experience in hearing care & aural management. In this interview, Dr. Wallace shares her insights on hearing loss, the latest advancements in hearing aids, and how Medicare beneficiaries can access the care they need. Whether you’re already experiencing hearing loss or simply planning for the future, her expertise offers invaluable guidance.

Q: How does untreated hearing loss affect a person’s overall health, independence, and quality of life?

A: Untreated hearing loss has been linked to every facet of someone’s life; Studies show untreated hearing loss is linked to a reduction in quality of life, increased loneliness & social isolation, poorer mood, and increased depression. In addition, there are effects on your earning potential, relationship strain, and, when severe enough, safety concerns that may impact one’s independence. Perhaps most compelling is the correlation with dementia… Untreated hearing loss, particularly in mid-life, has been found to be the largest potentially modifiable risk factor for dementia in large studies published by the Lancet Commission and Johns Hopkins, to name a few. I must emphasize, however, that this is an example of correlation and not causation, meaning hearing loss itself does not cause dementia, but they often happen together. In other words, there are some changes that result from hearing loss (changes to the brain, social behavior, and cognitive load) that we know are not good for brain function. The good news is there is a robust body of evidence supporting the reversal of many of these negative effects of unmanaged hearing loss when hearing loss is managed through audiologic care, including the use of hearing aids, auditory training, or cochlear implantation. 

Q: How often should seniors get hearing exams, and why is it important to do so?

A: Ideally, folks over the age of 65 should be getting annual hearing tests, first to establish a baseline and to assess changes thereafter. This is particularly important for two reasons: 1. We are not very good at perceiving our own hearing sensitivity. The best course of action is to actually measure it to allow for more timely intervention, which will ultimately lead to better outcomes. 2. Not only does hearing loss become more prevalent as we age, but so do other health conditions that may increase your risk of hearing loss. Hearing is an important part of your overall health management, particularly when we think about healthy aging and maintaining independence. 

Q: Are there specific signs that indicate a senior should seek hearing care?

A: If you’ve never had a formal hearing test, or haven’t had a hearing test in a number of years, I highly recommend you get a test to establish a baseline. There is a lot of power in simply knowing your hearing sensitivity, and there is never an expectation for you to move forward immediately with hearing aids. Beyond that, it is important for you to have an honest look at your hearing – are you asking others to repeat themselves? Do you feel less confident at parties or social gatherings? Are you avoiding the phone? Do you need closed captions on your TV? Are family members or loved ones noticing your hearing? It might be uncomfortable to think about, but there is no shame in hearing loss.

There is a great questionnaire called the Hearing Handicap Inventory for Adults; this is a free online tool that may be a good place to start, whether it’s for yourself or for a family member. Lastly, it is recommended to pursue hearing care if you have ringing or buzzing in your ears (tinnitus), and medical evaluation by an ENT is recommended for any pain, fullness, discharge, dizziness, or sudden changes in hearing. 

Q: Have hearing aids evolved in terms of technology and usability and pricing for seniors? If so, how?

A: Hearing aids have changed drastically over the last 5 years, and even more dramatically when compared to those of previous generations. Modern hearing aids are essentially tiny computers- they have chips inside that use advanced algorithms to sample the sounds in your listening environment (up to thousands of times per second!) and automatically adjust themselves to the most appropriate setting for your environment. For example: are you at the beach with windy noise? Reading in a quiet room? At the theater? Eating out at a restaurant? All of these are very different environments from an acoustic perspective, and today’s hearing aids can automatically adjust & compensate appropriately.

Further, hearing aids are programmed uniquely to your own ears and tailored to sensitive areas across the frequency spectrum (or ‘pitches’) that you may have trouble with. Nowadays, they can go a step further to determine what amplification method(s) to employ based on the nature of the incoming sound in real time (ie. Dialogue vs. ambient noise vs. musical sounds, etc.). In this regard, it is almost like having a sound mixer in your ears.

While all of this might sound overwhelming, the good news is the advancements in technology have allowed for nearly all of this work to happen behind the scenes – and is based on how the audiologist programs your hearing aids. As the hearing aid user, all you must worry about is putting them in in the morning, taking them out at night, and some minimal cleaning. Hearing aids are often rechargeable now and offer Bluetooth connectivity if those are additional features you desire. 

Q: What are the core features that patients should consider when comparing different hearing aid models and brands?

A: The top priorities should always be sound quality for the user and practicality. 1: is it giving you the improvement you need in as natural a sound quality as possible? And 2: Can you use the hearing aids daily? Do they create more problems than they solve? I encourage anyone interested in exploring hearing aids to hear it for yourself – visit your Audiologist and demo multiple models from different manufacturers. From there, I’d say it’s the audiologist’s job to guide you on the pros and cons of all the additional features and considerations based on your unique hearing needs.

For example, you may desire the smallest hearing aid on the market, but your ear anatomy and/or severity of hearing loss may tell us that this is not the best treatment option for you. In addition, I think it’s important to mention if you intend to use your hearing aids everyday, make sure your audiologist understands your daily life. Maybe you are an avid golfer; you’d then need a hearing aid that can deal with wind noises well. If you love audiobooks, Bluetooth streaming may be important. If your hands aren’t working quite like they used to, rechargeable devices may be easier to use. 

Q: What are some common misconceptions about hearing care or hearing aids that you wish more people understood?

A: A lot of people think that hearing care equals hearing aids and that hearing aids are a “plug and play” solution. Your auditory system is quite complex, however, and hearing loss can lead to significant distortion and/or permanent damage to the hearing organs. There is a lot that goes into properly fitting hearing aids, and how the devices are programmed is far more important than the technology itself. If they are not set up appropriately for your hearing loss and anatomy, you will be substantially limiting your hearing aid benefit, if not further impacting your hearing abilities. I’d also mention that hearing aids, even when programmed well, should not be thought of as a “cure-all” solution; unfortunately, hearing loss is irreversible. We employ hearing aids to essentially harness & repurpose the hearing capacity that you have left.  You may need to use other tools like good communication strategies, remote microphones, or auditory training programs to maximize your benefit. 

Q: Could you talk about some of the social aspects of hearing loss? How may hearing loss affect one’s social life?

A: Evidence shows untreated hearing loss is linked to social isolation and loneliness, as well as reduced fulfillment in interpersonal relationships. To me, this is the most important aspect of hearing loss to consider. This also tends to be the most powerful motivator for people to do something about their untreated hearing. If you notice yourself withdrawing from conversation, opting out of social gatherings, or choosing not to take part in activities that typically bring you joy, I’d highly encourage you to think about how your hearing may be factoring in.

I’d also think about whether this is affecting anyone else in your life. There is something called Third Party Disability, which is the idea that your health condition could have an impact on loved one even if they do not have the condition themself. This is very common for people with hearing loss. For example, if one person in a married couple is withdrawing from social situations, odds are it will begin to impact the social life of their spouse as well. The good news is hearing loss management leads to a reversal of many of these negative social effects, not just for the person with hearing loss but also their loved ones. 

Q: What role(s) do family members or caregivers play in supporting seniors with hearing loss, and how can they be more involved in the process?

A: Family members can be very valuable assets to an audiology appointment. Because hearing loss tends to occur gradually over time, it is common for people’s loved ones to pick up on the hearing loss before they recognize it in themselves. To put it simply- you don’t know what you don’t hear. I find it helpful, when done tactfully, for family members to share their perspective and insights. The key, however, is to continue to emphasize that this is coming from a caring place and wanting the best for them. It should never be combative or a blame game, especially if the person is in denial. When a family member does pursue hearing care, I encourage you to be supportive and patient. Hearing loss and hearing aids are not easy! There may be a learning curve and there may still be times when you’ll need to repeat yourself. Just continue to be supportive and encouraging. As far as day-to-day maintenance, family members can be helpful to check if the hearing aids are inserted properly, the devices are being charged, or the batteries have been changed, and potentially taking on some of the tasks that require good vision and dexterity if those are concerns for the patient. 

Q: Could you share some important statistics on hearing loss amongst seniors today and/or overtime?

A: A simplification of the prevalence of hearing loss with age is that roughly 60% of people in their 60s, 70% of people in their 70s, 80% of people in the 80s and over 90% of people in their 90s have hearing loss. The odds are it will affect you at some point in your life!

Over 50 million adults in the United States have hearing loss and it ranks as the third most prevalent chronic condition in the US. Yet, only about 20% of people who would benefit from hearing aids actually use them. There are many contributing factors that tell us why this is the case, but the top 3 typically are: not perceiving enough difficulty, stigma, and price/cost.

Q: Do you ever encounter patients struggling to afford hearing aids? If so, what advice do you offer to seniors seeking affordable solutions?

A: Yes, unfortunately. Traditionally, hearing aids have not been covered, or are fairly limited in their coverage. This includes Medicare and dates back to how audiologists were categorized as providers with CMS and an outdated understanding of hearing treatment. Hearing aids typically retail anywhere from $3000 – $7000 for a pair through most practices, with no assistance from insurance. There are a few supplemental plans that may offer some limited coverage, but I’d be sure to read those benefits carefully to understand if there is a particular manufacturer of hearing aid or clinic you must use to take advantage of the benefit. If hearing aids remain out of reach, you can discuss a payment plan with the audiologist, consider an older model, see if you qualify for services through the VA if you are a veteran, look for funding through local organizations, determine if Costco is appropriate for you, or check if you meet the criteria for over the counter hearing aid options. There are also a few non-profits out there who offer hearing aids, but that will depend on your region.

Q: What advice would you give to seniors about selecting a hearing care provider or audiologist?

A: I think it is very important for you to select a hearing provider / audiologist you can trust. Typically, it is a good sign when an audiologist works with multiple hearing aid manufacturers because this will give you as many care options as possible. I’d find one that is in a location that is accessible and with a schedule that works for you. I’d also ask them questions about how they approach clinical decision making to see if matches your preference. For example, some people want joint decision making and others prefer more of a “doctor-knows-best” strategy. Lastly, ask around and see if there is someone your community trusts. This could be through word-of-mouth or reading reviews online.

I’m also happy to answer any questions you may have! And if you believe being seen in your home would be best for you, please let me know! Anywhere Audiology sees residents throughout the New York Tristate Area and we’re proud to be an independent, brand agnostic team of doctors of audiology.

Advice from the Experts: Medicare Guidance at Emerald Medicare

We want to extend our heartfelt thanks to Dr. Kathleen Wallace for sharing her invaluable expertise on hearing care and hearing benefits. At Emerald Medicare, we are committed to supporting your health and well-being, which includes providing education on aligned health subjects that impact your quality of life.

If you’d like to explore your Medicare options or need personalized advice, our expert team is here to help. Click below to schedule an appointment with one of our licensed brokers through Calendly, or contact us directly at the number or email below.

Contact Us:

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