Medicare Part D

Still Working at 65 in Sterling Heights? How Medicare Fits In

Sterling Heights, MI — Turning 65 while you're still on the job used to be a simple milestone. Today, it comes with real decisions. Should you sign up for Medicare? Delay it? Keep your employer plan? Drop it? Getting this wrong can mean lifelong penalties, so let's walk through it slowly.

If you live in Sterling Heights and you're still working — or your spouse is — here's how Medicare and job-based coverage fit together as you weigh choices for 2027.

First, know which coverage pays first

When you have both Medicare and employer insurance, one is the "primary payer" and the other is "secondary." This depends mostly on the size of the employer.

• Employer with 20 or more employees: Your group health plan usually pays first, and Medicare pays second.
• Employer with fewer than 20 employees: Medicare usually pays first, and your group plan pays second.

That second scenario matters. If Medicare is supposed to pay first and you haven't enrolled, you could be stuck with bills your employer plan won't cover. If you work for a smaller company in Sterling Heights, ask your HR department in writing which payer is primary before your 65th birthday.

Part A is usually a "yes." Part B is the real decision.

Most people qualify for premium-free Part A (hospital insurance) based on their work history, so enrolling at 65 rarely hurts. The one exception: if you contribute to a Health Savings Account (HSA), you can no longer contribute once any part of Medicare starts. Some workers delay Part A to keep making HSA contributions.

Part B (doctor and outpatient care) has a monthly premium. Whether to take it at 65 depends on whether your employer coverage counts as "creditable" and whether it's primary or secondary to Medicare.

If you delay Part B because you have qualifying employer coverage, you get a Special Enrollment Period of up to 8 months after that job-based coverage ends to sign up without a late penalty. COBRA and retiree coverage do not count as active employer coverage for this rule — a common and expensive mistake.

Don't forget Part D — even if you're still working

Part D covers prescription drugs. If your employer's drug coverage is "creditable" (at least as good as Medicare's), you can delay Part D with no penalty. Your plan is required to send you a Creditable Coverage Notice each year — save it.

If your employer plan is not creditable and you go more than 63 days without Part D or comparable coverage, you'll owe a permanent late enrollment penalty when you eventually sign up.

Some Part D facts worth knowing as you compare 2026 and 2027:

• The maximum annual deductible is $615 in 2026 and $700 in 2027.
• Your out-of-pocket costs are capped at $2,100 in 2026 and $2,400 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 (single filer, 2026) or the higher joint threshold, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your Part B and Part D premiums. IRMAA is based on your tax return from two years ago, so a big income year in 2024 could raise your 2026 premiums. If you've had a life change — retirement, divorce, loss of a spouse — you can appeal.

What's available around Sterling Heights

If you eventually decide to leave your employer plan for Medicare Advantage or a stand-alone Part D plan, availability is set at the county level. Sterling Heights is in Macomb County, where a range of Medicare Advantage and Part D plans are offered each year. The exact 2027 lineup is in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder, so always check before making a switch.

The main windows to know:

• Initial Enrollment Period: The 7-month window around your 65th birthday.
• Special Enrollment Period: Up to 8 months after employer coverage ends.
• Annual Enrollment Period: October 15 – December 7.
• Medicare Advantage Open Enrollment: January 1 – March 31.

Common mistakes to avoid

1. Assuming COBRA counts as active coverage. It doesn't. Your Part B clock starts when your job-based coverage ends, not when COBRA ends. 2. Forgetting to stop HSA contributions before Medicare begins. 3. Missing the Creditable Coverage Notice and getting hit with a Part D penalty years later. 4. Not checking who pays first. Ask HR — in writing — before your birthday month.