Medicare Supplement

Working past 65 in Toledo? How Medicare fits with job coverage

TOLEDO, Ohio — More people are working past 65 than a generation ago, and many are wondering the same thing: do I have to sign up for Medicare now, or can I stay on my employer's health plan?

Still on the job at 65? You're far from alone in Toledo

The short answer is that it depends on the size of your employer, the type of coverage you have, and what makes sense for your household. Here's a plain-English look at how Medicare coordinates with job-based insurance, plus what's changing in 2026.

The size of your employer changes everything

When you're 65 or older and still working, Medicare's rules say one of two things is true:

• If your employer has 20 or more employees, your job-based plan usually pays first, and Medicare pays second (if you enroll).
• If your employer has fewer than 20 employees, Medicare usually pays first, and your job-based plan pays second.

That second rule matters a lot. If you work for a small business in Toledo and skip Medicare Part B, your employer plan may only pay the portion it would have paid after Medicare. You could be left with big bills for services Medicare would have covered.

This is one of the first things to confirm with your HR or benefits office before your 65th birthday.

Part A is usually a no-brainer. Part B is the real decision.

Most people qualify for premium-free Part A (hospital insurance) because they or a spouse paid Medicare taxes long enough. If that's you, enrolling in Part A when you turn 65 is generally harmless — unless you contribute to a Health Savings Account (HSA). Once you're on any part of Medicare, you can no longer make new HSA contributions.

Part B (doctor visits and outpatient care) carries a monthly premium, so the choice is more personal:

• If your employer coverage is solid and your company has 20+ employees, you can often delay Part B without penalty and enroll later through a Special Enrollment Period.
• If your employer is small, or your coverage is retiree or COBRA insurance, delaying Part B can cause gaps and lifelong late-enrollment penalties.

Watch the calendar — and the fine print on "creditable" coverage

Two words to remember: creditable coverage. That's Medicare's term for job-based drug coverage that's at least as good as Medicare Part D. Your plan should send you a notice each year telling you whether your prescription coverage is creditable.

If it is, you can delay Part D without penalty. If it isn't, and you go more than 63 days without creditable drug coverage, you'll owe a late-enrollment penalty for as long as you have Medicare.

Key dates to know:

• Initial Enrollment Period: the 7-month window around your 65th birthday.
• Special Enrollment Period: up to 8 months after your job or job-based coverage ends, to sign up for Part B without penalty.
• Annual Enrollment Period: Oct. 15 – Dec. 7 each year.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31.

What's new for 2026

A few program-level updates worth knowing when you compare Medicare to what you have at work:

• The Part D out-of-pocket cap is $2,100 in 2026. Once your prescription costs hit that ceiling, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap was eliminated in 2025. Part D now has just three phases.
• The Medicare Prescription Payment Plan lets you spread your yearly drug costs into predictable monthly payments — helpful if you have expensive medications.
• IRMAA surcharges (extra premiums for higher earners) start above $109,000 in income for a single filer in 2026, based on your 2024 tax return.

What's available around Toledo

Toledo sits in Lucas County, where Medicare plan choices are set at the county level. That means the number of Medicare Advantage and stand-alone Part D plans available to you is the same whether you live in West Toledo, Old Orchard, or anywhere else inside county lines.

If you're weighing whether to leave your employer plan for Medicare — or you'll retire soon — the official Plan Finder at medicare.gov lets you enter your ZIP code and your prescriptions to see how each Lucas County plan would treat your specific drugs and doctors.