My spouse and I are approaching 65, but I am still working and have good health coverage through my employer. Do we need to enroll in Medicare?

If you or your spouse are working past age 65 and have health insurance through an employer, you may be able to delay enrolling in Medicare without a late enrollment penalty. The rules depend, however, on the size of your employer.

As a refresher, original Medicare has two parts, Part A and Part B. Part A, which covers hospital care, is premium-free for most people. Part B, which covers doctor visits, lab tests and outpatient care, has a monthly premium of $202.90 in 2026. Higher-income individuals (over $109,000) and couples (over $218,000) pay more for Part B under Income-Related Monthly Adjustment Amounts.

If you are already receiving Social Security benefits, you will automatically be enrolled in Parts A and B when you turn 65, and your Medicare card will be mailed to you. The card will include instructions for declining Part B if you have employer coverage that allows you to delay Part B enrollment.

If you are still working

Start by talking with your benefits manager or human resources department to understand how your employer insurance works with Medicare. In most cases, it makes sense to enroll in Part A since it is free for eligible individuals. However, if you contribute to a Health Savings Account (HSA), enrolling in Part A will make you ineligible to continue HSA contributions.

Small employer

Whether you should enroll in Part B usually depends on the size of your employer. If your employer has fewer than 20 employees, Medicare becomes your primary insurance. In this case, you should enroll in Part B during your Initial Enrollment Period, which is a seven-month window that starts three months before your 65th birthday, includes the month you turn 65 and ends three months after your birthday month.

If you are not receiving Social Security benefits, you will need to apply for Medicare. You can do this online at ssa.gov/medicare/sign-up, by phone at 800-772-1213 or in person at your local Social Security office.

If you miss your Initial Enrollment Period, you will need to wait for the General Enrollment Period, which runs January 1 through March 31. Coverage begins the first day of the month after you enroll, but a 10% penalty is added to your Part B premium for each full year you have waited. Signing up on time helps you avoid both coverage gaps and added costs.

Large employer

If your employer has 20 or more employees, your group health plan remains your primary insurance while you are actively working. In this case, you generally do not need to enroll in Part B at 65 if your coverage is adequate. If you do enroll, Medicare will serve as secondary coverage. Once your employment or employer coverage ends, you will have an eight-month Special Enrollment Period to sign up for Part B without penalty.

Check your drug coverage

You should also review your prescription drug coverage. Ask your benefits manager if your employer’s plan is considered “creditable.” If it is, you do not need to enroll in a Medicare Part D plan. If it is not creditable, you should sign up for Part D during your Initial Enrollment Period to avoid a penalty. The penalty is typically 1% of the national average premium for each month you delay. You can compare Part D plans at medicare.gov/plan-compare.

Need help?

For free guidance, contact your State Health Insurance Assistance Program at 877-839-2675 or shiphelp.org. You can also call the Medicare Rights Center helpline at 800-333-4114.

Navigating Medicare while you are still working can be confusing, but checking with your employer and understanding the rules can help you avoid costly mistakes. Taking the time to make informed decisions now will ensure you have the coverage you need and help you avoid unnecessary penalties down the road.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.