Medicare 2026

Medicare and Workplace Health Plans: A Blacksburg Guide

Plenty of Blacksburg residents are hitting 65 while still clocking in — at Virginia Tech, at Carilion, at Montgomery County schools, or at a small business they built themselves. If that's you, the big question isn't whether to enroll in Medicare. It's how Medicare works alongside the health plan you already have through your job.

The good news: you have options, and the rules are clearer than they look. The catch: a wrong move can mean a lifelong penalty or a gap in coverage. Here's what to know.

Who pays first depends on your employer's size

Medicare uses "coordination of benefits" rules to decide which insurance pays first when you have both. The size of your employer is the key factor, according to Medicare.gov.

If your employer has 20 or more employees, the group health plan is the primary payer. Medicare pays second and may cover some costs the employer plan doesn't.

If your employer has fewer than 20 employees, Medicare generally pays first. In that case, enrolling in Medicare Parts A and B at 65 is usually important — otherwise you could be left owing the share Medicare would have paid.

This matters in Blacksburg, where workplaces range from large systems like Virginia Tech to small downtown shops on Main Street. The rule doesn't change based on where you live — it changes based on who signs your paycheck.

Should you take Part A at 65?

For most people, yes. Part A (hospital insurance) is premium-free if you or your spouse paid Medicare taxes for at least 10 years. Signing up doesn't cost you anything extra and can help pick up some hospital costs your employer plan leaves behind.

One important exception: if you contribute to a Health Savings Account (HSA), you must stop HSA contributions once you enroll in any part of Medicare, including Part A. If you want to keep contributing to your HSA, you may want to delay Part A — but be aware that if you're already collecting Social Security, Part A enrollment is automatic and can't be refused without giving up Social Security benefits.

What about Part B?

Part B (doctor and outpatient care) comes with a monthly premium, so many people with strong employer coverage delay it to avoid paying twice. That's allowed — as long as your employer coverage counts as "creditable" and your employer has 20 or more employees.

When you or your spouse eventually stop working (or lose that coverage), you get a Special Enrollment Period of up to 8 months to sign up for Part B without a late-enrollment penalty. Missing that window can mean a permanent premium surcharge, so mark the date you lose coverage.

COBRA and retiree coverage do not count as active employer coverage for this purpose. If you're on COBRA at 65, you generally still need to enroll in Part B on time.

Prescription drugs: don't overlook Part D

If your employer plan includes drug coverage, ask HR whether it's "creditable" — meaning at least as good as Medicare's standard Part D benefit. Your plan is required to tell you this in writing each year.

If it is creditable, you can delay Part D without penalty. If it isn't, and you go more than 63 days without creditable drug coverage, you could face a lifelong Part D late fee.

A few Part D facts worth knowing for planning purposes:

• The out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027.
• The old "donut hole" coverage gap is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly installments if you choose.

Higher earners: watch for IRMAA

If your income is above $109,000 as a single filer (or $218,000 filing jointly) in 2026, you'll pay an income-related monthly adjustment (IRMAA) on top of your Part B and Part D premiums. Social Security uses your tax return from two years earlier to decide. Working professionals in Blacksburg with strong salaries should factor this in when weighing whether to enroll in Part B while still employed.

Local snapshot: where to get help in Blacksburg

Blacksburg sits in Montgomery County, where a range of Medicare Advantage and Part D plans are available through Medicare's plan finder if you decide to shop. But before you compare plans, get your coordination question answered first — because the employer-versus-Medicare decision shapes everything else.

Free, unbiased help is available through VICAP, Virginia's State Health Insurance Assistance Program (SHIP). Counselors don't sell anything and don't earn commissions. The New River Valley Agency on Aging serves the Blacksburg area and can connect you with a VICAP counselor by phone or in person.

Key enrollment windows to remember:

• Medicare Annual Enrollment Period: October 15 – December 7
• Medicare Advantage Open Enrollment Period: January 1 – March 31
• Special Enrollment Period after losing job coverage: up to 8 months for Part B