Medicare 2026

Drexel Hill workers turning 65: Medicare and job coverage

If you live in Drexel Hill and you're approaching 65 while still on the job, you may be wondering whether you need to sign up for Medicare right away — or whether your employer plan is enough. The answer depends on the size of your employer, how Medicare and your workplace coverage coordinate, and a few deadlines that are easy to miss.

Here's a plain-English guide to help you sort it out before you make a move you can't undo.

Who pays first: the size of your employer matters

Medicare uses "coordination of benefits" rules to decide which insurance pays first when you have more than one plan. According to Medicare.gov, 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 usually pays first and the group plan pays second.

That distinction matters. If Medicare is supposed to be your primary payer and you haven't enrolled, you could be stuck with bills your employer plan won't cover.

Part A at 65: usually a yes

Most people qualify for premium-free Part A (hospital insurance) at 65 because they or a spouse paid Medicare taxes long enough while working. Because there's no premium, many people sign up for Part A even if they keep their employer plan.

One big exception: if you contribute to a Health Savings Account (HSA), you cannot keep contributing once any part of Medicare — including Part A — starts. Medicare enrollment can also be backdated up to six months. If you plan to keep making HSA contributions, talk with your benefits office before enrolling.

Part B: the piece you can delay (sometimes)

Part B covers doctor visits and outpatient care, and it has a monthly premium. If you have creditable employer coverage from a company with 20 or more employees, you can generally delay Part B without a late-enrollment penalty.

If you don't have qualifying coverage and you skip Part B, you may face a lifetime penalty added to your premium — 10% for every full 12 months you were eligible but didn't enroll. Ask your HR department for written confirmation that your plan qualifies you to delay.

The 8-month window when work coverage ends

Once your employment or group coverage ends — whichever comes first — you have a Special Enrollment Period of 8 months to sign up for Part B without a penalty. COBRA and retiree coverage do not count as active employer coverage for this purpose, so don't assume COBRA buys you more time.

Sign up as soon as you can. Waiting until the last minute can create a gap in coverage.

Part D and prescription drug coverage

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 penalty. Your plan should send you a creditable-coverage notice each year — keep it.

For 2027, Part D includes several important changes worth knowing about:

• A $2,100 out-of-pocket cap on covered prescriptions in 2026, rising to $2,400 in 2027.
• A maximum deductible of $615 in 2026, rising to $700 in 2027.
• The old coverage gap ("donut hole") is gone as of 2025.
• An optional Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments.

What's available locally

Drexel Hill is in Delaware County, where Medicare beneficiaries can choose Original Medicare (with or without a standalone Part D plan and a Medigap policy) or a Medicare Advantage plan offered by a private insurer. The number of plans available in the county changes each year, and the Annual Enrollment Period runs Oct. 15 through Dec. 7. If you're already in a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period runs Jan. 1 through March 31 and lets you make one change.

Higher earners should also know about IRMAA — an income-related surcharge on Part B and Part D premiums that begins above $109,000 in income for a single filer in 2026 (based on your tax return from two years earlier).