Medicare Advantage

Still Working at 65 in Juneau? How Medicare Fits Your Costs

JUNEAU, Alaska — If you're turning 65 and still on the job, Medicare doesn't have to be an all-or-nothing choice. But before you decide how it fits with your employer plan, it helps to understand the cost structure Medicare itself sets each year — because those numbers, not marketing, are what shape your real bill.

For 2027, the Part D pieces are locked in. CMS publishes the 2027 Part B premium and deductible later this fall. Knowing these numbers makes the coordination question with your job's health plan much easier to think through.

Start with the cost pieces Medicare sets

Medicare has four parts, and each carries its own cost structure that the government — not your employer — controls:

• Part A (hospital): Most people pay no premium if they or a spouse worked and paid Medicare taxes long enough. There is still a per-admission hospital deductible.
• Part B (doctor/outpatient): Has a standard monthly premium and an annual deductible set by CMS each year.
• Part C (Medicare Advantage): Bundles A and B (and usually D) through a private plan; costs vary by plan.
• Part D (prescription drugs): Has its own premium, deductible, and — new in recent years — a hard cap on what you pay out of pocket.

If you keep your employer plan and delay Part B, you skip that Part B premium for now. If you take Part B, you'll pay it on top of anything your job coverage costs. That trade-off is the heart of the working-past-65 decision.

What Part D looks like in 2027

Part D got a real overhaul, and 2027 continues it.

• The annual out-of-pocket cap is $2,400 in 2027 (it is $2,100 in 2026). Once your spending on covered drugs hits that number, you pay nothing for the rest of the calendar year on covered prescriptions.
• The maximum deductible a Part D plan can charge is $700 in 2027 (it is $615 in 2026). Some plans set it lower.
• The coverage gap ("donut hole") is gone as of 2025. Part D now moves through three phases — deductible, initial coverage, and catastrophic — instead of the old four.
• The Medicare Prescription Payment Plan lets you spread that out-of-pocket spending across the calendar year in monthly installments instead of paying it all at the pharmacy counter. It's optional and doesn't lower your total — it just smooths it.

If your employer plan already has strong drug coverage that's considered "creditable," you may not need Part D right now. If it doesn't, that $2,400 ceiling in 2027 is worth weighing.

IRMAA: the income surcharge to know about

Higher earners pay more for Parts B and D through the Income-Related Monthly Adjustment Amount, or IRMAA. In 2026, it kicks in above $109,000 in income for a single filer (higher thresholds for joint filers). The Social Security Administration uses your tax return from two years back to decide.

For someone still working at 65 with a good salary, this matters. Enrolling in Part B while you're earning peak income can trigger a surcharge you wouldn't have paid if you'd delayed — assuming your employer coverage qualifies you to delay without penalty. A life-change event (like retiring) can be appealed.

Coordinating with employer coverage — the cost lens

Ask three plain questions:

1. Is my employer plan primary or secondary? At employers with 20 or more workers, the job plan is generally primary and Medicare is secondary. At smaller employers, it's often the other way around — which usually means you need Part B on time. 2. Is my drug coverage creditable? Your HR or benefits office can tell you in writing. If yes, you can delay Part D without a late penalty. If no, the clock is ticking. 3. Does adding Part B (and its premium) actually buy me something? Sometimes it lowers your out-of-pocket exposure; sometimes it just duplicates what you already have.

There's no single right answer — it depends on your paycheck, your plan, and your health.

How many plans are offered here

Juneau is in Juneau City and Borough, and Medicare plan availability is set at the county level. The exact count of Medicare Advantage plans and stand-alone Part D plans offered in the borough is published each fall by CMS and shown on the Medicare Plan Finder at Medicare.gov. Counts can shift year to year as carriers enter or leave the market, so it's worth checking the current-year list rather than relying on last year's memory.

Dates to keep on the calendar

• Initial Enrollment Period: the seven months around your 65th birthday.
• Special Enrollment Period: up to 8 months after employer coverage ends, to sign up for Part B without a late penalty.
• Annual Enrollment Period: October 15 – December 7, to join, switch, or drop Medicare Advantage and Part D plans.
• Medicare Advantage Open Enrollment: January 1 – March 31, for people already in a Medicare Advantage plan to make one change.