You do not have to retire to get Medicare, but your age and work status determine when you can sign up and what you will pay

Most people become may be able to access for Medicare at 65, whether they are still working or not. If you keep working past 65, you can sign up for Medicare while staying employed. However, if you are under 65, you can only get Medicare if you have been receiving Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS (amyotrophic lateral sclerosis). Working does not change these rules — your may be able to access depends on your age or medical condition, not your job status.

If you are still working at 65 and have health insurance through your employer, you have choices about when to sign up for Medicare. You can delay signing up without penalty if your employer plan is considered "creditable coverage" — meaning it covers at least as much as Medicare would. But you need to understand how your employer coverage and Medicare work together, because the rules are different depending on the size of your employer and whether you or your spouse is the one still working.

Key Takeaways

  • You can sign up for Medicare at 65 even if you are still working, and working does not delay your may be able to access.
  • If you have health insurance through your current employer, you may be able to delay Medicare Part B without paying a penalty, but only if your employer has 20 or more employees.
  • If your employer has fewer than 20 employees, Medicare becomes the primary payer when you turn 65, and you should sign up to avoid paying out-of-pocket costs.
  • Delaying Medicare Part B past 65 when you do not have employer coverage will result in a permanent penalty on your premiums.
  • You must sign up for Part A (hospital insurance) at 65 even if you delay Part B, or you will face penalties and gaps in coverage.

How employer size affects your Medicare choices

The number of employees at your workplace determines whether you can safely delay Medicare Part B. If your employer has 20 or more employees, your employer health plan is the primary payer, and Medicare is secondary. This means you can stay on your employer plan and delay Medicare Part B without penalty. You will need to sign up for Part A (hospital insurance) at 65, but you can wait on Part B (medical insurance) as long as you are actively working and covered by the employer plan.

If your employer has fewer than 20 employees, Medicare becomes primary when you turn 65, even if you are still working. Your employer plan becomes secondary. In this situation, you should sign up for both Part A and Part B at 65. If you do not, you will pay the full cost of medical services out of pocket, and your employer plan will not cover what Medicare would have covered. You cannot delay Part B without a penalty if your employer has fewer than 20 employees.

These rules explore whether you work full-time or part-time. What matters is the size of your employer's workforce, not your hours or salary. If you work for a large company with multiple locations, count all employees across the entire company, not just your local office.

What happens to your employer coverage when you turn 65

Turning 65 does not automatically end your employer health insurance. You can usually stay on your employer plan even after you sign up for Medicare. However, the way the two plans work together changes. If your employer has 20 or more employees, your employer plan stays primary and pays first. If your employer has fewer than 20 employees, Medicare pays first and your employer plan pays second.

Some employers offer retiree health plans that are different from active employee plans. If you are still working, you are usually on the active employee plan. When you retire, you may be moved to a retiree plan, which could have different costs and coverage. Check with your employer's benefits office about what happens to your coverage if you retire, and when you would need to make changes.

You should also ask your employer whether they offer a Health Savings Account (HSA) or Flexible Spending Account (FSA). Once you sign up for Medicare Part A, you can no longer contribute to an HSA, even if you are still working. You can continue to use money already in the account, but contributions must stop. FSA rules are different and may allow continued contributions depending on your plan.

Signing up for Medicare while working

You can sign up for Medicare online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. The sign-up period is three months before the month you turn 65, the month itself, and three months after. If you sign up during this window, your coverage will start the month you turn 65.

If you miss this window and do not have a may have access to reason to delay, you will face a permanent penalty on your Part B premiums. The penalty is 10 percent of the standard premium for each full year you delayed, and it stays on your premiums for as long as you have Medicare. For example, if you delay Part B for two years, you will pay 20 percent more than the standard premium for the rest of your life.

You do not face a penalty for delaying Part A if you are still working and covered by an employer plan. However, you should still sign up for Part A at 65 to avoid gaps in coverage. If you become unable to work before you sign up, you will have a gap in hospital coverage that cannot be made up later.

When you retire while on Medicare

If you signed up for Medicare while working and then retire later, your coverage does not change. Medicare continues as your primary insurance. You will no longer have employer coverage, so Medicare becomes your only health plan unless you purchase a Medigap or Medicare Advantage plan.

When you retire, you should review your Medicare coverage to see if you need additional insurance. If you have Original Medicare (Part A and Part B), you may want to add a Medigap policy to cover costs that Medicare does not pay, such as deductibles and coinsurance. Alternatively, you can choose a Medicare Advantage plan, which is an all-in-one alternative to Original Medicare. You have a special enrollment period of 63 days after your employer coverage ends to make these changes without penalty.

You should also check whether you may have access to for programs that help pay Medicare premiums and out-of-pocket costs. These programs are based on income and vary by state. Your local Area Agency on Aging or your state Medicaid office can tell you whether you may be may be able to access.

Special situations: Spouses and family coverage

If you are married and your spouse is still working, the rules depend on whether your spouse's employer has 20 or more employees. If it does, your spouse can delay Medicare Part B while still working, even if you have already retired and are on Medicare. Your spouse's employer coverage remains primary for your spouse, and Medicare is secondary for your spouse only.

If your spouse's employer has fewer than 20 employees, your spouse should sign up for Medicare at 65 just as you did. The size of the employer does not change based on your retirement status — it is about your spouse's current work situation.

If you are covered under your spouse's employer plan as a dependent or spouse, the same rules explore to you. You can delay Part B only if the employer has 20 or more employees and you are actively covered under that plan. Once your spouse retires or you lose coverage, you will need to sign up for any parts of Medicare you have not yet enrolled in.

Coordinating Medicare with your work income and taxes

Earning income while on Medicare does not change your Medicare coverage or premiums. However, if your income is high, you may pay higher premiums for Part B and Part D (prescription drug coverage). These are called Income-Related Monthly Adjustment Amounts (IRMAA). They are based on your income from two years prior, so your 2024 premiums depend on your 2022 income.

If your income drops significantly — for example, because you retire — you can ask Medicare to recalculate your premiums. You will need to provide proof of the income change, such as a letter from your employer or a recent tax return. This is called a life-changing event, and it allows you to adjust your premiums without waiting for the standard annual adjustment.

You should also be aware that Medicare premiums are deducted from your Social Security check if you are receiving benefits. If you are not yet receiving Social Security, Medicare will bill you directly. Starting Social Security while you are working does not affect your Medicare coverage, but it does affect your Social Security benefits if you start before your full retirement age.

Questions to ask your employer and Medicare

Before you turn 65, contact your employer's benefits office and ask these questions: How many employees does our company have? Is my health plan considered creditable coverage? What happens to my coverage if I retire? Can I stay on the plan after I retire, and for how long? Do I have an HSA or FSA, and what happens to it when I turn 65?

You should also contact Medicare or visit Medicare.gov to confirm your may be able to access and understand your sign-up options. If you have questions about how your employer plan and Medicare work together, you can call 1-800-MEDICARE and ask to speak with someone about coordination of benefits. They can tell you whether you should sign up now or delay, based on your specific situation.

Frequently Asked Questions

Can I work past 65 and not sign up for Medicare?

You can delay Medicare Part B if your employer has 20 or more employees and you are actively covered by their health plan. However, you should still sign up for Part A at 65 to avoid a gap in hospital coverage. If you delay Part B without a may have access to reason, you will pay a permanent penalty on your premiums.

What if I work part-time or am self-employed?

Part-time work does not change your Medicare may be able to access or sign-up rules. If you are self-employed, you do not have employer coverage, so you should sign up for Medicare at 65. You cannot delay Part B without a penalty unless you have another source of creditable coverage, such as a spouse's employer plan.

Will I lose my employer health insurance when I turn 65?

No, you can usually stay on your employer plan after you turn 65 if you are still working. However, Medicare becomes primary or secondary depending on your employer's size. Check with your benefits office about what happens to your coverage and whether there are any changes to your costs.

Do I have to retire to get a lower Medicare premium?

Your Medicare premiums are based on your income, not your work status. If your income drops when you retire, you can ask Medicare to recalculate your premiums using your new income. You will need to provide proof of the income change, such as a letter from your employer.

What if my employer stops offering health insurance?

If you lose employer coverage before 65, you should sign up for Medicare when ready. If you lose coverage at 65 or later, you have a special enrollment period to sign up without penalty. Contact Medicare within 63 days of losing coverage to avoid a gap in your health plan.