Medicare 2026

Medicare and employer health coverage in Russellville

# Still working at 65? How Medicare coordinates with employer…

RUSSELLVILLE, Ark. — Turning 65 while you're still on the job used to feel simple: keep your work insurance and worry about Medicare later. Today, the decision is trickier. Whether you should sign up for Medicare, delay it, or pair the two depends on the size of your employer, the kind of coverage you have, and a few deadlines that are easy to miss.

Here's a plain-English guide to how Medicare works alongside employer coverage — and the mistakes that can cost you money or leave you without drug coverage when you need it.

Who pays first: the size of your employer matters

Medicare uses "coordination of benefits" rules to decide which insurer pays first when you have two forms of coverage. The dividing line is the size of the employer.

• 20 or more employees: Your group health plan is the primary payer, and Medicare is secondary. Many people in this situation delay Part B to avoid paying a premium for coverage they aren't using yet.
• Fewer than 20 employees: Medicare is usually primary, and your employer plan pays second. In this case, you generally need to enroll in Medicare at 65, because your employer plan may only cover what Medicare doesn't — leaving big gaps if you skip Part A or B.

If you're not sure which rule applies to you, ask your HR or benefits office in writing. Get the answer on paper.

Part A is usually a yes; Part B is the real decision

Most people qualify for premium-free Part A (hospital insurance) at 65 because they or a spouse paid Medicare taxes long enough. Since it usually costs nothing, many workers sign up for Part A even while keeping their job plan.

There's one exception: if you contribute to a Health Savings Account (HSA), enrolling in any part of Medicare — including Part A — stops you from making new HSA contributions. Talk with your benefits office before signing up if you want to keep funding an HSA.

Part B (doctor and outpatient care) has a monthly premium, so the choice is bigger. If your employer coverage is solid and the company has 20+ employees, you may choose to delay Part B until you retire.

Don't miss your Special Enrollment Period

This is where people get tripped up. When your job-based coverage ends — because you retire, cut hours, or lose the insurance — you get an 8-month Special Enrollment Period (SEP) to sign up for Part B without a late penalty.

Two important warnings:

• COBRA does not count as active employer coverage for Medicare purposes. Your SEP clock starts when your job coverage ends, not when COBRA ends.
• Retiree health coverage doesn't count either. Once you leave the active workforce, sign up for Part B during your SEP or risk a lifetime penalty and a gap in coverage.

If you miss the window, you may have to wait for the General Enrollment Period (January 1 – March 31) and pay a Part B late penalty for as long as you have Medicare.

Drug coverage: is your employer plan "creditable"?

If you keep employer coverage past 65, ask HR one specific question: Is our prescription drug coverage "creditable"? That means it's expected to pay, on average, at least as much as a standard Medicare Part D plan.

• If yes, you can delay signing up for Part D with no penalty. Keep the notice they give you — you'll need it later.
• If no, you should enroll in a Part D plan when you're first eligible, or you'll owe a permanent late-enrollment penalty when you finally join one.

Part D includes a hard cap on what you pay out of pocket for covered drugs — $2,100 in 2026 and $2,400 in 2027 — and the Medicare Prescription Payment Plan lets you spread those costs across the year in monthly installments if you choose.

What's available locally when you're ready

Russellville is in Pope County, where Medicare beneficiaries can choose from Original Medicare (Parts A and B, often paired with a standalone Part D plan and sometimes a Medigap policy) or a Medicare Advantage plan that bundles coverage through a private insurer. The number of Advantage and Part D plans offered in Pope County changes each year, and you can compare current options at Medicare.gov using your ZIP code.

The Annual Enrollment Period runs October 15 – December 7 each year, and the Medicare Advantage Open Enrollment Period runs January 1 – March 31 for people already in an Advantage plan.

A note on higher-income workers

If you're still earning a strong income at 65, be aware of IRMAA — the income-related monthly adjustment amount. In 2026, IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer (higher thresholds apply for joint filers). IRMAA is based on your tax return from two years earlier, so a big work year now can affect your Medicare premiums later.