Medicare Advantage

Nashville Workers Past 65: Medicare and Job Coverage

Davidson County has 69 Medicare Advantage plans for 2027. Compared with 2026, 14 plans are not coming back, 9 are new, and 30 continuing plans changed in some way you should check before December 7, 9 of them under a new name. This guide covers what those numbers mean for Nashville, not which plan to pick.

NASHVILLE, Tenn. — More Tennesseans are staying on the job past 65, and that's raising a practical question at kitchen tables across Davidson County: If I already have health insurance through work, do I need to sign up for Medicare too?

The short answer is it depends — mostly on the size of your employer and how your current coverage is structured. Getting the timing right matters, because a missed deadline can mean lifelong late penalties and gaps in coverage.

Here's a plain-language guide to how Medicare coordinates with employer insurance when you're still working.

First, know which coverage pays first

Medicare uses "coordination of benefits" rules to decide which insurance pays first (the primary payer) and which pays second (the secondary payer).

• If your employer has 20 or more employees: Your group health plan usually pays first, and Medicare pays second.
• If your employer has fewer than 20 employees: Medicare typically pays first, and your employer plan pays second.

That distinction is important. If you work for a small employer, you generally need to enroll in Medicare when you're first eligible — otherwise, you could be left with big gaps in what gets paid.

You can confirm how your specific plan coordinates with Medicare by asking your HR or benefits administrator.

Part A is often an easy call

Most people qualify for premium-free Part A (hospital insurance) at 65 because they or a spouse paid Medicare taxes for at least 10 years. Since it doesn't cost anything, many workers sign up for Part A at 65 even if they keep their employer coverage.

One big exception: If you contribute to a Health Savings Account (HSA), you cannot keep making HSA contributions once you enroll in any part of Medicare, including Part A. If you want to keep funding your HSA, you may want to delay Part A enrollment. Talk to your benefits team before deciding.

Part B: to delay or not to delay

Part B (doctors and outpatient care) has a monthly premium, so this is where the real decision usually lies.

If your employer coverage counts as "creditable" and the company has 20+ employees, you can generally delay Part B without a late penalty. When you eventually leave that job or lose the coverage, you'll get an 8-month Special Enrollment Period to sign up for Part B without penalty.

If you don't have creditable employer coverage and skip Part B, you could face a permanent 10% penalty for each 12-month period you were eligible but didn't enroll.

Part D and prescription drug coverage

The same "creditable coverage" idea applies to prescription drugs. Employer plans are required to send you an annual notice telling you whether their drug coverage is at least as good as Medicare Part D. Save that letter.

Here's what to know about Part D as you compare 2027 coverage:

• The out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
• The maximum deductible is $615 in 2026 and $700 in 2027.
• The old coverage gap ("donut hole") is gone — as of 2025, Part D has just three phases.
• The Medicare Prescription Payment Plan lets you spread drug costs across monthly payments instead of paying big amounts at the pharmacy counter.

If your employer drug coverage isn't creditable and you delay Part D, you may owe a late enrollment penalty later.

Higher earners: watch for IRMAA

If your income is on the higher side, you may pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part B and Part D premiums. In 2026, IRMAA kicks in for single filers with income above $109,000 (based on your tax return from two years earlier). Married couples filing jointly have higher thresholds.

This is worth thinking about if you're still drawing a strong salary in your 60s.

What's available in the Nashville area

Nashville is in Davidson County, where Medicare Advantage and Part D plan availability is set at the county level. When you're ready to compare what's offered locally, the official Plan Finder at Medicare.gov shows every plan available in your ZIP code.

Two dates to circle on the calendar:

• October 15 – December 7: Medicare Annual Enrollment Period (change Part D or Medicare Advantage for 2027).
• January 1 – March 31: Medicare Advantage Open Enrollment (for people already in an MA plan who want to switch or return to Original Medicare).