Medicare Supplement

Working at 65 in Allentown? How Medicare Fits Employer Plans

ALLENTOWN, Pa. — More people are working past 65 than a generation ago, and that raises a question the Medicare handbook doesn't always answer clearly: If you already have health coverage through your job, do you need to sign up for Medicare too? For workers in Allentown and the rest of Lehigh County, the answer depends on a few specific details — and getting it wrong can lead to lifelong penalties.

Here's a plain-language guide to how Medicare coordinates with employer coverage, and the mistakes to sidestep.

Start with the size of the employer

The single most important factor is how many people work for your employer (or your spouse's employer, if that's whose plan you're on).

• 20 or more employees: The group health plan generally pays first, and Medicare pays second. You can usually delay Part B without penalty while you keep working and stay on that plan.
• Fewer than 20 employees: Medicare typically pays first, and the employer plan pays second. In this case, you usually need to enroll in Parts A and B when you first become eligible, or your employer coverage may not pay much of your bills.

If you're not sure which category applies, ask your HR or benefits office in writing. Don't guess.

Part A is usually a no-brainer at 65

Most people qualify for premium-free Part A (hospital insurance) because they or a spouse paid Medicare taxes for at least 10 years. Since it costs nothing, many workers sign up for Part A at 65 even if they're keeping employer coverage.

One important 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 your HSA matters to you, talk with your benefits office before signing up.

Part B — the decision that trips people up

Part B (doctor and outpatient care) has a monthly premium, so many workers delay it while they're on solid employer coverage. That's often fine — if the employer has 20 or more employees and the coverage counts as "primary."

The mistake to avoid: assuming any job-based coverage lets you delay Part B. COBRA and retiree coverage do not count as active employer coverage for Medicare purposes. If you leave your job and go on COBRA at 65, you still need to enroll in Part B on time, or you could face a late-enrollment penalty that lasts for life.

Your Special Enrollment Period

When your employment or the employer coverage ends, you get an 8-month Special Enrollment Period to sign up for Part B without penalty. The clock starts the month after your job ends or the group coverage ends — whichever comes first.

Two tips:

1. Don't wait until month 8. If you time it wrong, you could have a gap with no coverage. 2. Get proof of coverage. Ask HR for a completed CMS form L564 (Request for Employment Information). Social Security will ask for it when you enroll.

What about Part D and drug coverage?

If your employer plan includes prescription drug coverage, check whether it's considered "creditable" — meaning it's at least as good as standard Medicare Part D. Your plan is required to tell you this each year in a written notice. Keep those letters.

As long as your drug coverage is creditable, you can delay Part D without a penalty. If it isn't, and you go more than 63 days without creditable coverage, you'll owe a Part D late-enrollment penalty when you eventually sign up.

A few 2026 Part D facts worth knowing, whenever you do enroll:

• The out-of-pocket cap is $2,100 for covered drugs.
• The maximum deductible is $615.
• The old "donut hole" coverage gap is gone — Part D now has three phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments across the year, if that helps your budget.

A quick note on higher-income workers

If you're still earning a strong salary, be aware of IRMAA — the income-related surcharge added to Part B and Part D premiums. For 2026, it kicks in above $109,000 in income for a single filer (higher thresholds apply for joint filers). Social Security uses your tax return from two years earlier, so a big income year in your mid-60s can raise your Medicare premiums later.

Plan choices in Lehigh County

If you eventually leave employer coverage and want to look at Medicare Advantage or a stand-alone Part D plan, availability is set at the county level. Allentown is in Lehigh County, and the specific plans and carriers offered there can be viewed on the plan finder at Medicare.gov by entering your ZIP code.

Two enrollment windows to keep on your calendar:

• Annual Enrollment Period: October 15 – December 7 (changes take effect January 1).
• Medicare Advantage Open Enrollment: January 1 – March 31 (for people already in a Medicare Advantage plan who want to switch or drop it).