Medicare 2026

Medicare and Your Job: When to Enroll if You're Still Working

DULUTH, Ga. — More people are working past 65 these days, and that raises a common question: do you still need to sign up for Medicare if you already have health insurance through your job? The answer depends on a few key details — and getting it wrong can lead to lifelong penalties or gaps in coverage.

Here's a plain-English guide to how Medicare works alongside employer coverage, and what Duluth-area workers should know before their 65th birthday.

Your first big question: how big is your employer?

The size of the company you (or your spouse) work for is the single most important factor.

• If the employer has 20 or more employees, your job-based health plan usually pays first, and Medicare pays second. In most cases, you can delay enrolling in Part B without penalty while you keep that coverage.
• If the employer has fewer than 20 employees, Medicare typically pays first. That means you generally need to enroll in Parts A and B at 65, even if you keep the employer plan — otherwise, the employer plan may not cover much.

If you're not sure which category applies, ask your HR or benefits office directly. Get the answer in writing if you can.

Part A is usually a simple "yes"

Most people qualify for premium-free Part A (hospital insurance) because they or a spouse paid Medicare taxes for at least 10 years. If that's you, enrolling in Part A at 65 is generally a low-risk move — it can even help pay some hospital costs your employer plan doesn't cover.

One important exception: if you contribute to a Health Savings Account (HSA), you (and your employer) must stop HSA contributions once Medicare starts. Enrolling in Part A means the door closes on new HSA deposits. Many workers time their Medicare enrollment around this rule.

Part B is where timing really matters

Part B (doctor visits and outpatient care) has a monthly premium, so many people with strong employer coverage choose to delay it. That's allowed — if your employer coverage qualifies as "creditable" for Part B purposes (generally, a group plan from an employer with 20+ employees).

When you eventually retire or lose that coverage, you get an 8-month Special Enrollment Period to sign up for Part B without a late penalty. Miss that window, and you could face a permanent 10% premium increase for every 12 months you were eligible but didn't enroll.

COBRA and retiree coverage do not count as active employer coverage for this purpose. That's one of the most common — and costly — mistakes people make.

Don't forget Part D (prescription drugs)

Your employer's drug coverage may or may not be considered "creditable" — meaning at least as good as standard Medicare drug coverage. Your plan should send you a notice each year telling you which it is. Keep those notices.

If your drug coverage is creditable, you can delay Part D without penalty. If it isn't, you'll want to enroll in a Part D plan when you're first eligible to avoid a lifetime late fee.

A few 2026 figures worth knowing, per Medicare.gov:

• Part D out-of-pocket cap: $2,100 for the year.
• Part D maximum deductible: $615.
• The old "donut hole" is gone — drug coverage now has three phases.
• The optional Medicare Prescription Payment Plan lets you spread drug costs across monthly payments.
• IRMAA surcharges (higher premiums for higher earners) start above $109,000 in income for a single filer.

What this looks like in Duluth

Duluth is in Gwinnett County, where Medicare beneficiaries have a wide range of stand-alone Part D and Medicare Advantage options available at the county level. If you're still working and covered through your job, you don't need to shop those plans yet — but it's worth knowing they'll be there when you do transition off employer coverage.

Two enrollment windows to keep on your calendar:

• Annual Enrollment Period: October 15 – December 7
• Medicare Advantage Open Enrollment: January 1 – March 31

A simple checklist before you turn 65

1. Ask HR whether your employer has 20+ employees and whether your drug coverage is "creditable." 2. Decide whether to enroll in Part A (watch the HSA rule). 3. Decide whether to delay Part B based on your employer's size and your coverage. 4. Save every "creditable coverage" notice you receive. 5. When you do leave the job, act within the 8-month Special Enrollment Period.