Medicare 2026

Turning 65 in Kirkwood? How Medicare Meets Your Job Plan

Kirkwood, Mo. — More people are working past 65 than a generation ago, and that raises a very practical question: if your employer still covers you, do you also need to sign up for Medicare? The short answer is "it depends on the size of your employer" — and getting that call right can save you from lifelong late-enrollment penalties.

The big question: who pays first?

Medicare uses "coordination of benefits" rules to decide which insurance pays your bill first. 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 is usually primary — which means you likely need to enroll in Part B at 65 to avoid gaps in coverage.

Kirkwood is in St. Louis County, and the rule is the same whether you work in Clayton, downtown St. Louis, or from a home office off Manchester Road. It's your employer's size that matters, not your ZIP code.

Should you take Part A at 65?

Part A (hospital insurance) is premium-free for most people who have worked at least 10 years (40 quarters) paying Medicare taxes. Because there's no monthly cost, many people sign up at 65 even while still working.

There's one important exception: if you contribute to a Health Savings Account (HSA), you must stop HSA contributions once any part of Medicare begins — including Part A. If keeping your HSA matters to you, talk to your benefits office before enrolling.

What about Part B?

Part B (doctor and outpatient care) has a monthly premium, so this is where the "delay or enroll" decision really matters.

• Large employer (20+): You can usually delay Part B without penalty as long as you have "current employment" coverage.
• Small employer (fewer than 20): You generally need Part B at 65, because the group plan expects Medicare to be primary.

When your job-based coverage ends — whether you retire or lose the plan — you get an 8-month Special Enrollment Period to sign up for Part B without a late penalty. COBRA and retiree coverage do not count as "current employment" for this rule, which trips up a lot of people.

Part D and prescription drugs

If your employer plan includes drug coverage that Medicare considers "creditable" (at least as good as Medicare's), you can delay Part D. Your plan's administrator must tell you each year whether the coverage is creditable — keep those notices.

If you go more than 63 days without creditable drug coverage after your Initial Enrollment Period, a Part D late-enrollment penalty may be added to your premium for as long as you have Medicare.

A few figures worth knowing:

• Part D out-of-pocket spending is capped at $2,100 for the year.
• The Part D maximum deductible is $615.
• The coverage gap (the old "donut hole") is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly installments if that helps your budget.

A quick word on IRMAA

If your income is higher — for 2026, above $109,000 for a single filer — you may pay an Income-Related Monthly Adjustment Amount on top of your Part B and Part D premiums. Working income counts, so if you're still earning at 65, factor this in when deciding whether to take Part B now or later.

Enrollment periods to remember

• Initial Enrollment Period: The 7-month window around your 65th birthday.
• Special Enrollment Period: 8 months after job coverage ends, for Part B.
• Annual Enrollment Period: Oct. 15 – Dec. 7, for changes to Part D and Medicare Advantage.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31, for people already in an Advantage plan.

Kirkwood residents can also compare Medicare Advantage and Part D options at the county level. St. Louis County has a wide range of plans available; medicare.gov's Plan Finder lets you enter your ZIP code and see what's offered.