Medicare 2026

Does Your Employer Have 20+ Workers? Medicare Rules

Reaching 65 used to mean retirement. Today, plenty of people in Morrisville are still clocking in — at the Research Triangle, at small businesses along Chapel Hill Road, or from a home office. If that's you, the big question isn't whether to take Medicare. It's how to fit Medicare around the health coverage you already have.

Turning 65 while still working in Morrisville

The rules aren't complicated once you see them laid out. But the wrong move — like skipping Part B when you should have signed up — can lead to lifelong late penalties. Here's how to think it through.

The size of your employer matters most

The single most important factor is how many people work for your employer.

• 20 or more employees: Your group health plan is the "primary" payer, and Medicare is secondary. Most people in this situation can safely delay Part B (and sometimes Part A, if they contribute to an HSA) until they retire or lose the job coverage.
• Fewer than 20 employees: Medicare usually becomes the primary payer once you're eligible, even if you keep the job plan. That means if you don't enroll in Part A and Part B at 65, your employer plan may pay very little — leaving you on the hook for the rest.

If you're not sure which category your employer falls into, ask your HR or benefits office in writing. They deal with this question all the time.

Part A: usually free, usually worth taking

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 often a simple call — it can act as backup coverage alongside your job plan.

One exception: if you contribute to a Health Savings Account (HSA), you cannot keep making HSA contributions once you're enrolled in any part of Medicare, including Part A. Some workers choose to delay Part A for that reason. Talk with your benefits office before deciding.

Part B: the piece with the penalty

Part B (doctor and outpatient care) has a monthly premium, and it also has a late enrollment penalty that can stick with you for life if you sign up late without a valid reason.

The good news: if you have "creditable" coverage through a current employer (yours or your spouse's), you qualify for a Special Enrollment Period. Once that job coverage ends, you get 8 months to sign up for Part B without a penalty.

A few things to watch out for:

• COBRA and retiree coverage do not count as current employer coverage for this purpose. The 8-month clock starts when your active employment ends, not when COBRA runs out.
• If you miss the window, you may have to wait for the General Enrollment Period and pay a permanent penalty.

Part D: don't forget your prescriptions

Prescription drug coverage has its own late penalty. If your employer plan includes drug coverage that Medicare considers "creditable" (at least as good as standard Part D), you can delay Part D without a penalty. Your plan is required to send you a notice each year telling you whether your drug coverage is creditable. Keep those notices.

For 2026, standalone Part D plans have a maximum deductible of $615 and a new $2,100 out-of-pocket cap on covered drugs. There's also an optional Medicare Prescription Payment Plan that lets you spread drug costs across the year in monthly installments. Those numbers can help you compare your employer's drug benefit to what Medicare offers.

What's available around Morrisville

Morrisville is in Wake County, where a range of Medicare Advantage and standalone Part D plans are offered each year. Availability, networks, and drug lists can change from one year to the next, so it's worth reviewing your options each fall during the Annual Enrollment Period (Oct. 15 – Dec. 7) — even if you're happy with your current setup.

If you're higher-income, keep IRMAA in mind: Part B and Part D premiums include an income-related surcharge for single filers with income above $109,000 in 2026 (based on your tax return from two years earlier).

A simple decision checklist

Before you make a move, walk through these questions:

1. Does my employer have 20 or more employees? 2. Is my current drug coverage creditable? (Check the annual notice.) 3. Am I contributing to an HSA I want to keep funding? 4. When do I actually plan to stop working? 5. Have I compared what I pay now to what Medicare would cost?

Your local SHIIP (North Carolina's State Health Insurance Assistance Program) offers free, unbiased counseling — a good next step if any of the answers above are murky.