Medicare Part D
Medicare and Employer Plans: Raleigh Worker's Guide
RALEIGH, N.C. — Turning 65 while still clocking in at a Research Triangle employer? You're far from alone. Wake County is one of North Carolina's fastest-growing counties, and a rising share of workers here are hitting Medicare age without leaving their jobs. That raises a practical question: do you sign up for Medicare, stay on your employer's plan, or do both?
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Click to call 855-729-3240Key takeaways
- If your employer has 20 or more workers, you may be able to delay Part B without a penalty, but only if you keep qualifying coverage the whole time.
- Once your job-based coverage ends, you get a Special Enrollment Period of up to 8 months to sign up for Part B without a late fee.
- Enrolling in any part of Medicare, including Part A, means you must stop contributing to a Health Savings Account, and many people stop contributions about six months early since Part A can be backdated that far.
- For 2026, Part D drug coverage includes a $2,100 yearly out-of-pocket cap, a $615 maximum deductible, and no more coverage gap, while IRMAA income surcharges kick in above $109,000 for single filers based on your 2024 tax return.
Here's a plain-English guide to how the two coverages fit together — and the deadlines you don't want to miss.
Start with the size of your employer
The single most important factor is how many people work for your employer.
- 20 or more employees: Your group health plan pays first, and Medicare pays second if you enroll.
- Fewer than 20 employees: Medicare typically pays first, and your employer plan pays second. In this case, most people should enroll in Part A and Part B at 65 to avoid coverage gaps.
If you're not sure which category your employer falls into, ask your HR or benefits office — in writing, if possible. This one detail changes almost every decision that follows.
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 costs anything and can supplement employer coverage.
Part B (doctor visits and outpatient care) carries a monthly premium. If your employer has 20 or more workers and offers solid coverage, you may choose to delay Part B until you retire. If you delay correctly — meaning you have qualifying employer coverage the whole time — you'll get a Special Enrollment Period of up to 8 months after that job or coverage ends to sign up without a late penalty.
Delay Part B without qualifying coverage, and you could face a lifetime late-enrollment penalty. This is the mistake that trips up the most working seniors.
Watch out for HSAs
If you contribute to a Health Savings Account (HSA) through work, note that you cannot keep contributing once you enroll in any part of Medicare, including Part A. Many people stop HSA contributions about six months before starting Medicare, because Part A can be backdated up to six months when you enroll after 65.
Talk with your benefits team or a tax advisor before you file — this is worth getting right.
Prescription drug coverage: check the "creditable" letter
Each fall, your employer plan should send a Notice of Creditable Coverage telling you whether its drug benefit is at least as good as Medicare's Part D. Keep that letter.
- If your employer drug coverage is creditable, you can delay Part D without a late penalty.
- If it isn't creditable, enrolling in a stand-alone Part D plan (or an Advantage plan that includes drugs) at 65 usually makes sense to avoid a permanent penalty.
For 2026, Part D has important consumer protections built in: a $2,100 annual out-of-pocket cap on covered drugs, a maximum deductible of $615, and the elimination of the old "donut hole" coverage gap that was phased out in 2025. There's also the optional Medicare Prescription Payment Plan, which lets you spread your drug costs into monthly installments instead of paying big amounts at the pharmacy counter.
Higher earners: know about IRMAA
If you're still working, you may still be earning a healthy income — and that matters for Medicare premiums. In 2026, IRMAA surcharges (extra amounts added to Part B and Part D premiums) begin above $109,000 for single filers and higher thresholds for joint filers. Medicare uses your tax return from two years earlier, so 2024 income drives 2026 premiums. If your income has since dropped — say, you've cut back hours or retired mid-year — you can ask Social Security to reconsider using Form SSA-44.
When you finally leave the job
When your employer coverage ends, your 8-month Special Enrollment Period for Part B begins. You'll also get a 2-month window to join a Medicare Advantage or Part D plan.
Raleigh is in Wake County, where a range of Medicare Advantage and stand-alone Part D options are available. You can compare what's offered in your ZIP code using the Plan Finder at Medicare.gov.
Also keep the standard enrollment windows in mind:
- Annual Enrollment Period: October 15 – December 7
- Medicare Advantage Open Enrollment: January 1 – March 31
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Wake County
(MA penetration in Wake County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Q: I turn 65 next month and plan to keep working for a big company. Do I have to do anything?
Q: My spouse is on my employer plan. Does their Medicare situation change?
Q: Can I keep contributing to my HSA if I only sign up for Part A?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.