Turning 65 and signing up for Medicare is a huge milestone. There are a lot of coverage types to choose from, even if you are still employed. If this is the case, you may consider signing up for Medicare Part A and delaying Part B coverage. This is an option if you or your spouse is working and receiving employer health benefits. Signing up for Medicare Part A may help you save money on some health services, like hospitalization, if you have more expenses than your employee plan covers. Delaying Part B enrollment will also allow you to avoid paying that premium, which is $202.90 a month in 2026. 

Parts A and B explained     

Medicare Part A is commonly known as hospital insurance. It helps you pay for inpatient hospital care and critical access hospitals. It also pays for skilled nursing facilities, hospice care, and some home health services.   

Medicare Part B, on the other hand, pays for you to see your doctor and for outpatient services. Part B covers preventive care including vaccines and health screenings. It also pays for mental health care, some medical equipment, and ambulance services. 

Is Medicare Part A free? 

About 99% of people who enroll in Medicare Part A pay no monthly premiums. The exception is if they haven’t worked at a job that withheld Medicare taxes for 40 quarters (which totals about 10 years of work). If you haven’t met that requirement, your premiums for Part A coverage for 2026 will be $311 per month or $565 per month, depending on how long you paid into Medicare. 

Note: You should also be aware that you will no longer be able to contribute to your Health Savings Account (HSA) once you are enrolled in any part of Medicare, including Medicare Part A. You should stop contributions six months before your eligibility because Medicare backdates your plan six months prior to enrollment. If you contribute beyond that date, you could end up with a tax penalty. You can, however, continue to use the HSA funds until they are depleted.  

Delaying Part B enrollment

You can refuse Medicare Part B and only sign up for Part A at age 65 if you have creditable insurance through your employer. To be creditable, your employer’s plan must offer prescription drug coverage that is as robust as Medicare’s prescription drug plan (Part D). It generally applies to employers with more than 20 employees because those health plans are as good as Medicare policies. Your employer must tell you annually if their plan is creditable. If you don’t know, speak with someone in your human resources department.

You may also need to sign up for Part A if you have veteran’s benefits or take part in a COBRA health plan from a former employer. Once eligible for Medicare, these plans may end or only cover a portion of your healthcare costs. To get more information on these plans, contact the Veteran’s Administration or your State Health Insurance Assistance Program for COBRA policies. 

Instructions for How to Enroll in Part A Only

You are eligible to enroll in Part A at the start of your initial enrollment period: the three months before you turn 65, and any time after that if you are covered by an employer. You will enroll in Part A through the Social Security Administration or Railroad Retirement Board (not through Medicare.gov). 

To enroll, you need to:

1. Have your Social Security number on hand. 
2. Know the city, state and country in which you were born. 
3. Know your start and end dates for your employer health plan. 
4. Make sure you click on the Apply Online button under the heading “Sign up for Medicare” on the Social Security Administration’s page. Do not click the button under the heading “Sign up for Part B Only.” 

If you need assistance with the process, you can call the Social Security Administration at 1 (800) 772-1213 (Monday through Friday, 8 a.m. to 7 p.m.) and tell them you want to enroll in Medicare Part A only. You can also apply in person by going to your local Social Security office, where appointments are recommended. 

What happens next?

Once you have enrolled in Medicare Part A, you will receive a welcome packet within about two weeks with information on your plan and your red, white, and blue Medicare card. Make sure to check your card to ensure there is a “Hospital (Part A)” enrollment date, but no date for “Medical (Part B).”

Since you have health insurance coverage through your employer, your Part A plan will be a secondary payer when you have a hospital stay. The employer plan pays its portion and Medicare covers excess costs.

Part A: Medicare enrollment’s first steps for working seniors

Medicare Part A can be an important part of insurance coverage for working seniors. If you are 65 or older and are covered by your employer’s health plan, it may help you save money and become comfortable with the Medicare system before you enroll at retirement. 

When you, or your spouse, retire or lose that coverage, you have an eight-month Special Enrollment Period to include Part B in your plan without paying a late enrollment penalty. You’ll need to enroll in Part D within 63 days of losing prescription drug coverage through your employer to avoid a late fee there as well. To learn more about Medicare’s special enrollment periods, visit https://smartmatch.com/medicare-resources/medicare-enrollment-periods/.