Are You Eligible for Medicare If You Work?

When a person turns 65, they are typically eligible to enroll in Medicare. In some instances, automatic enrollment applies for Medicare Part A. This is usually when a person has worked for at least ten years, also called 40 credits or quarters with employers who withhold Medicare taxes.

However, people who continue to work past the age of 65 may feel that they may not need to enroll in Medicare if a health plan at work already covers them. Federal rules may still require them to be covered by Medicare—even if they already have insurance—depending on the number of employees the company they work for employs.

If an organization offers group health insurance and employes 20 or more people, an employee is not required to sign up for Medicare at 65. The health plan they currently have is their primary insurance, and Medicare is secondary insurance. However, if they are working for a smaller organization that has less than 20 employees, it is advised to enroll in Medicare Parts A, and B and Medicare will become the primary insurance.

What If I Haven’t Worked Long Enough to Qualify for Medicare?

If you have not worked the qualified quarters or credits, you may not qualify for Medicare Part A without paying a premium. Part A is hospital insurance that typically is covered during employment by your payroll taxes. However, most generally, you could qualify for Part B and pay monthly premiums that cover outpatient care, doctor services, and medical equipment, and Part D prescription coverage. Years of employment are not qualifications for Part A and Part D.

If you have a spouse age 62 or older and they worked the qualified credits, or your spouse is deceased, you may qualify for premium-free Part A based off of their work history.

Basically, regardless if you work or not, you will qualify for Medicare Part A. The caveat is whether you are eligible for premium-free Part A. If the above circumstances do not apply, you can pay Medicare monthly premiums for Part A. The cost of premiums change yearly based on the number of work credits or quarters that you have completed.

What happens if you have Medicare Part A and a Health Savings Account?

Often, companies offer their employees health insurance called a High-deductible Health Plan with a Health Savings Account (HSA). A high deductible health plan allows funds to be put into the HSA by both the employer and employee and is not taxed and is used towards paying eligible medical expenses. However, if an employee enrolls in Medicare Part A or Part B, no payments can be made to their HSA. All the funds that have been built up over time can be taken out to pay for qualified medical expenses. Employees could also automatically be enrolled for Medicare Part A if they are receiving benefits like Social Security. If they delay these benefits, they can also delay Part A enrollment.

If an employee chooses to enroll in Medicare Part A, more than six months after they turn 65, with payments made towards their HSA during this period, they could incur a tax penalty, based on automatic Part A retroactive coverage that could apply. Penalties can be avoided if all payments towards their HSA is stopped six months before enrolling in Medicare Part A.

How does Medicare work with Employer Insurance?

When a person has both Medicare and a company insurance plan, each insurance party is usually called a “payer.” In this case, “coordination of benefits” is a rule that applies that determines which party pays a medical claim first. In case the company plan doesn’t cover all the medical expenses, the doctor or healthcare facility can pass on the bill to Medicare to pay the rest of it. Medicare will examine it and then decide to pay any extra amount due, based on their insurance coverage. If the claim is still unsettled, the onus will typically fall on the person to pay it themselves.

Medicare has several benefits, but it always helps to compare both an employer’s health insurance plans with Medicare before making a decision. In some cases, you may find that Medicare payments are cheaper than those made towards an employer’s health insurance. However, whatever you decide, do keep track of enrollment windows for Medicare so you can make the best of it and get maximum insurance coverage when you most need it.

If I work, am I mandated to take Medicare?

If you are working past the age of 65, and the company you work for has 20 full-time employees and provides health insurance, you may not need all parts of Medicare. You can delay Parts B and D and get them at a later date of retirement or if you lose the company-sponsored insurance. However, it is a best practice to enroll in Part A as soon as you are eligible at 65 regardless of employee health insurance coverage. It is free to join Medicare; however, if you have company-provided insurance, Part A will become your secondary insurance. If you delay taking Medicare at age 65 because you are still actively working, and covered under an employer group health insurance, but plan to stop working, you then qualify for a special enrollment period to enroll in Medicare.

If you are self-employed or work for a smaller company that has less than 20 employees, it is best to take Part A and Part B when you turn 65.

If you are no longer working, but have COBRA, it is best to enroll in Medicare when you turn 65 during the Initial Enrollment Period because COBRA is not considered employment-based health coverage and it does not qualify for the Special Enrollment Period once COBRA ends.

How to enroll in Medicare?

A person can enroll in Medicare by visiting the Social Security website, going to their local office or calling by phone.

  1. Online at www.SocialSecurity.gov.
  2. Call Social Security at 1-800-772-1213 (TTY users 1-800-325-0778), Monday through Friday, from 7 AM to 7 PM.

Even if you do not receive Social Security retirement benefits, you can still apply for Medicare benefits. Anyone who already receives Social Security benefits will automatically be enrolled in Medicare when they become 65 years of age. Typically, a Medicare card will be sent three months before the first day of their birthday month.

There is a 7-month window for a person to apply for Medicare Part A for that provides for hospital service coverage. This window opens three months before the month a person turns 65 and closes three months after.

What happens if you Delay Signing up for Medicare Part B?

Many people choose to sign up for Medicare Part A when they become 65 years of age because it is usually premium-free. Medicare Part B coverage includes a premium and helps to cover doctor’s visits, outpatient care, and tests. Often, people who sign up for Medicare end up signing up for both Parts A and B.

However, if a person is covered by a health insurance plan with an employer, or is covered by their spouse’s employer, they may choose to delay signing up for Part B. Another reason for postponing could be if a person is under 65 years, is working with a company that employs over 100 workers and is already receiving Social Security Disability payments.

If a person loses their health insurance at work and wants to be covered by Medicare Part B, they are usually given an eight-month window to enroll. If they miss this, they can incur a late enrollment penalty which amounts to 10% of the Part B premium charged for every year of delay.

In cases where a 65-year-old individual not covered by Medicare decides to apply, applying online may not be possible, and may have to make a personal visit to the Social Security office, or mail, their application with proof of coverage from their employer and, therefore, are not eligible for a penalty.

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