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If you're still working at 65, and have group coverage, you don't have to enroll in Medicare right away.

Do I need to sign up for Medicare at 65 if I’m still working?

Q: Do I need to sign up for Medicare at 65 if I’m still working?

2020 Medicare enrollment datesA: Medicare eligibility begins at age 65, and signing up on time can help you avoid premium surcharges. But if you’re working at 65, you get a bit more leeway.

Medicare eligibility starts at age 65. Your initial window to enroll is the seven-month period that begins three months before the month of your 65th birthday and ends three months after it. Seniors are generally advised to sign up on time to avoid penalties that could prove quite costly over the course of retirement.

Specifically, if you fail to sign up for Medicare on time, you’ll risk a 10 percent surcharge on your Medicare Part B premiums for each year-long period you go without coverage upon being eligible. (Since Medicare Part A is usually free, a late enrollment penalty doesn’t apply for most people.) If you’re still working at age 65, however, a different set of rules applies.

No need to double up on coverage

Many seniors are no longer employed at age 65, and thus rush to sign up for Medicare as soon as they’re able. But if you’re still working at 65, and you have coverage under a group health plan through an employer with 20 employees or more, then you don’t have to enroll in Medicare right away.

That said, it often pays to enroll in Medicare Part A on time even if you have health coverage already. It won’t cost you anything, and this way, Medicare can serve as your secondary insurance and potentially pick up the tab for anything your primary insurance (in this case, your work health plan) doesn’t cover.

The only exception is if you’re contributing to a health savings account and wish to continue doing so. Medicare enrollees are not allowed to contribute to an HSA, even if they continue to have coverage under an employer’s HSA-qualified high-deductible health plan.

Your Medicare special enrollment period

If your employer has at least 20 employees and you’re still working and covered under that plan when you turn 65, you can delay your enrollment in Medicare (specifically in Medicare Part B, which allows you to avoid the Part B premium while you’re covered under your employer’s plan). In that case, you’ll get an eight-month special enrollment period to sign up for Medicare if and when you leave your job or your employer stops offering coverage.  It will start the month after you separate from your employer, or the month after your group health coverage ends – whichever happens sooner.

Sign up during those eight months, and you won’t have to worry about premium surcharges for being late. And the eight-month special enrollment period is also available if you’re delaying Part B enrollment because you’re covered under your spouse’s employer-sponsored plan, assuming their employer has at least 20 employees.

But note that in either case, it has to be a current employer. If you’re covered under COBRA or a retiree plan, you won’t avoid the Part B late enrollment penalty when you eventually enroll, and you won’t have access to a special enrollment period to sign up for Part B — you’ll have to wait for the general enrollment period instead.

Run the numbers

Though you don’t need to enroll in Medicare at age 65 if you have coverage through a qualified group health plan, doing so might make sense if that plan isn’t heavily subsidized by your employer. Figure out what you’re paying for group health coverage and what your benefits look like under that plan, and then compare it to what you’ll pay under Medicare, taking into account the cost of everything from premiums to coinsurance to deductibles to copays.

Keep in mind that for comprehensive coverage under Medicare, you’ll need a Part D drug plan to accompany Parts A and B. Still, you might find that signing up for Medicare at 65 makes the most sense financially, even if you’re entitled to a special enrollment period later on.

Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.

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Related terms

Medicare Part A

Medicare Part B

Medicare Part D

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This is the most ridiculous system ever!!!!! That I should have to pay for medicare and regular health insurance as well Medicare is almost 200. then I have to enroll in another health plan which will cost a few more hundred dollars. Rediculous

Maurie Backman

You don’t need to pay for Medicare and health insurance at the same time. Once you’re eligible, you can sign up for Medicare and just pay its premiums. If you’re still working at age 65 and have a group health plan through work that you pay for, you don’t need to double-pay by enrolling in Medicare. And, you can keep your group health plan but sign up for Medicare Part A alone, which is free.

David McCall

What if I’m turning 65, not retiring, working full-time, my employer pays 100% of my insurance premiums, our coverage is EXCELLENT… HOWEVER, we have LESS THAN 20 employees. Can I still defer signing up for Medicare or can I sign up, but refuse benefits until such time that I do retire in the future. (I’m paranoid, because our coverage is so good, I don’t want to risk any kind coordination of benefits between my primary plan and the Medicare plan to mess up or confuse my current coverage.) Thank you!

Maurie Backman

The 20 employees is, unfortunately, a requirement, which means you won’t qualify for a special enrollment period if you delay Medicare. However, if you want to keep your current health plan and sign up for Medicare, it could act as a secondary payer — meaning, it could pick up the tab for costs your primary insurance doesn’t cover. You’re allowed to have Medicare in conjunction with other insurance.

Darlis G Smith

I will turn 65 on March 7, 2020 and I currently have health insurance for myself and my unemployed wife, and I an enrolled in an HSA which I contribute $1500 per year with a company deposit of $1000 per year, how does that affect me signing up for medicare part A.

Maurie Backman

You can no longer contribute to an HSA once you’re on Medicare. In fact, it’s advisable to stop HSA contributions up to six months prior to enrolling in Medicare, because you get up to six months of retroactive coverage through Part A. If you don’t stop HSA contributions, you could face a tax penalty.

Debra Norris

when you say “employer has at least 20 employees” – does that mean 20 full-time, part-time or a combo? do all 20 have to be covered by the group plan?

Maurie Backman

It doesn’t matter if your employer has 20 full-time or part-time employees; the threshold is 20 to be considered a group health plan for Medicare special enrollment purposes.

jo ellen smith

I will still working when I turn 65 and I work for a public school and will continue to work until i am 67. Do I have to carry my school insurance if medicare is less costly when I turn 65

Maurie Backman

Once you’re eligible for Medicare, you’re allowed to sign up. Medicare won’t reject your enrollment if you have another health plan. But in your case, if you keep your insurance through your job, Medicare will likely serve as your secondary insurance, and your employer’s insurance will be primary. Generally, you’re not forced to keep health insurance through a job if you don’t want it. And Medicare will certainly not require you to keep it once you sign up.

Thomas Snyder

What about my wife if she is covered on my employer’s plan?

Maurie Backman

That counts for a special enrollment period. Your wife can enroll in Medicare later on without penalty if she’s covered by your group health plan and your company employs at least 20 people.


Is the 6 month retroactive period for medicare from the day medicare coverage starts or the day you apply for medicare coverage. EX. I want medicare coverage to start nov 1. I apply Oct 1. Do I have to stop HSA contributions on April 1 (6 months back from date I apply) or May 1 (6 months back from date coverage starts.

Dianne Levisohn

I am covered through my husband’s plan (he is over 65) And, he did not sign up for Medicare part A; We are both still working (full time). And, we are continuing to contribute to our HSA account through his office (>20 employees). I just turned 65, myself and am still planning on working for 3 more years ( starting part time in an office with <20 employees). Here is my question: 1. When he retires, presumably at the end of 2020, will I have a problem signing up for Medicare part A at that time? 2. Am I required… Read more »

Eugene Siefker

I will be 65 in May 2020. At this time I work for an employer that has over 100 employees. I have insurance through my employer with a HSA account attached. I plan to work yet for a couple more years at least if health stays good. My wife is 3 months behind me in turning 65. She is also covered under my employers insurance as she does not work. Do I need to sign up for Medicare plan A and Plan B before turning 65 so as to avoid having to pay extra for the coverage later on because… Read more »

Stephen Marks

Thank you for a super helpful discussion, especially on the finer points of HSAs and Medicare!

Marion c.

Have been penalized for 15 yrs. Received Soc. Sec. at 65, but was not told to join Medicare. I retired at 70, had no insurance, was covered under my husbands plan as a NYC firefighter. Have complained over the years about the penalty, but to no avail. What can one do?

This sounds like a tricky situation. I’m sorry you find yourself in it. If somebody from the government (Medicare, Social Security, etc.) advised you not to take Part B when first eligible, you may qualify for “Equitable Relief” from your penalty. You can request relief if you have proof you were mislead by the government. You’d ask for help by writing a letter to Social Security with details of your specific situation.


Thank you so much for the above article. It is exactly what I need to read. It answered 95% of my questions.


I pay for my own healthcare. Can I sign up for Medicare at 65 and still work and cancel my our of pocket health care?


I turn 65 in March, 2020, am employed by a large company, and my husband is on my company’s health insurance (& he is 7 years younger than I am). I contribute to an HSA account. If I intend to keep working, do I have to alert Medicare by registering on their website, or do I take no action with Medicare until I am ready to retire? I also have a question about my contributions to my HSA account. Do I stop contributing about 6 months before I intend to retire? What if I decide to retire suddenly and have… Read more »

melody Pedersen

I turn 65 in February. I plan on working for a few more year. Currently I pay about $140 a month for health insurance. I have read about the different Medicare plans and if I continue to use my work place insurance until I retire, will I be penalized? Do I need to sign a waiver before I turn 65 so I am not penalized when I eventually switch to Medicare?

melody Pedersen

Oh and I forgot to mention that my work place insurance does have HSA.

Scott Kuball

So, if I’m still covered through my employer when I turn 65 and decide to enroll in Medicare, I will be charged a premium?

Whether you also have coverage through your employer has no bearing on whether you’ll pay a premium for Medicare.

I am still employed and myself and my wife are on La. Group Benefit Ins. through La.DOTD I am 69 yrs old, she has recently started working part time instead of full time does she have to sign up on Med. B as long as she is on my Ins. She is 70 yrs old

If you’re currently working full-time and she is covered through your plan, she may be able to safely delay enrolling in Medicare.

suzanne thorson

I will be eligible for Medicare in 3 months, work full time and have insurance through my company (20+) which is just ok. There is a steep inpat per day copay though so I think I will sign up for Medicare Part A. I contribute to a FSA, not a HSA. That is still okay though, right?

You are correct that unlike with a Health Savings Account (HSA), having Medicare Part A does not disqualify you from contributing to a Flexible Spending Account.