Medicare 2026

Still on the Job at 65 in Salem? Here's How Medicare Slots In

# Still on the Job at 65 in Salem? Here's How Medicare Slots…

SALEM, Mass. — Turning 65 while still clocking in doesn't automatically mean signing up for Medicare — but it does mean making some decisions. If you or your spouse have health coverage through work, the choice comes down to how the two systems talk to each other, and whether delaying parts of Medicare could cost you later.

Here in Salem, where many residents work well past their 60s at hospitals, schools, small businesses along Essex Street, and employers on the North Shore, the coordination rules are worth understanding before your birthday hits.

Who pays first depends on your employer's size

Medicare has clear rules about which insurance pays first when you have both. If your employer (or your spouse's employer) has 20 or more employees, the group health plan is the primary payer and Medicare is secondary. If the employer has fewer than 20 employees, Medicare generally pays first, and the group plan pays second.

That second scenario is the one that trips people up. If Medicare is supposed to be primary and you haven't enrolled, you could be stuck with bills your employer plan won't cover. If you work for a smaller Salem business, ask your HR contact or benefits administrator to confirm in writing how the plan coordinates with Medicare.

Part A at 65: almost always yes

Part A covers hospital stays, and most people who've worked at least 10 years have already paid for it through payroll taxes — meaning there's no monthly premium. For that reason, many people enroll in Part A at 65 even if they're keeping their job coverage.

The one big exception: if you contribute to a Health Savings Account (HSA), you must stop those contributions before Medicare (any part) starts. Medicare enrollment and HSA contributions can't overlap. Some workers coordinate their Part A start date carefully with their last HSA deposit for this reason.

Part B: delay only if your coverage is "creditable"

Part B covers doctor visits and outpatient care, and it has a monthly premium. You can delay Part B past 65 without a late penalty only if your employer coverage counts as creditable — meaning it's considered as good as Medicare for this purpose. Employer group health plans from companies with 20 or more employees usually qualify. Retiree coverage, COBRA, and VA benefits often do not count as creditable for delaying Part B.

If you delay Part B without qualifying coverage, you may face a late enrollment penalty that gets added to your premium — for life. When in doubt, ask your HR department for a written statement confirming your plan is creditable.

Your 8-month window when work coverage ends

When you (or your spouse) retire or lose employer coverage, Medicare gives you an 8-month Special Enrollment Period to sign up for Part B without penalty. The clock starts the month after employment or the group coverage ends, whichever comes first.

COBRA does not extend this window. Even if you take COBRA after leaving your job, the 8 months still count from your last day of active employment coverage. Missing that window can mean waiting until the next General Enrollment Period and paying a late penalty.

What about Part D and Advantage plans in Salem?

Part D covers prescription drugs. In 2026, Part D includes a $2,100 annual out-of-pocket cap and a maximum deductible of $615, and the old "donut hole" coverage gap is gone. There's also an optional Medicare Prescription Payment Plan that lets you spread drug costs across the year in monthly installments.

If your employer plan already includes creditable drug coverage, you generally don't need Part D right away — but you'll want a notice from your plan each year confirming that.

Salem is in Essex County, where Medicare Advantage and stand-alone Part D options are set at the county level. If and when you're ready to compare, you can see every plan available in your ZIP code using the Plan Finder tool at Medicare.gov.

Key dates to remember

• Initial Enrollment Period: the 7-month window around your 65th birthday.
• Special Enrollment Period: 8 months after employer coverage ends.
• Annual Enrollment Period: October 15 – December 7 each year.
• Medicare Advantage Open Enrollment: January 1 – March 31.

Higher earners should also know that IRMAA surcharges — extra amounts added to Part B and Part D premiums — begin above $109,000 in income for a single filer in 2026.