Whether you’ve just turned 65 or are getting closer to retiring, it’s important to research your Medicare options while you’re still working so you can make smart choices that will pay off later. Understanding the basics of how Medicare works allows you to enroll in coverage that fully meets your needs while keeping healthcare costs in check. 

From Part A and Part B to private coverage, here’s what you need to know about Medicare for working seniors. 

Am I eligible for Medicare if I’m 65 and working?

You become eligible for Medicare once you turn 65, and generally must enroll during a seven-month Initial Enrollment Period (IEP) to avoid late enrollment penalties. At a minimum, you will need to enroll in Medicare Part A for hospital coverage and Part B for medical insurance. However, if you have qualifying health coverage through your or your spouse’s job, you may be able to delay Medicare enrollment without penalties.

Working seniors can enroll in Medicare during their IEP or wait until retirement. Here’s how to check your eligibility:

• Employers with less than 20 employees: You will need to enroll in Medicare within your IEP
• Employers with 20 or more employees: You can drop your employee coverage and enroll in Medicare Parts A and B, enroll in Medicare Part A and/or Part B alongside your existing coverage, or delay your enrollment
• Health coverage through your spouse: Varies based on their employer’s plan and policies

Your employee benefits manager can help you understand your options and determine whether enrolling in Medicare or delaying your enrollment is best. Here are a few questions to ask:

• If you enroll in Medicare, will your or your spouse/family’s health benefits change?
• Will Medicare work with your employee coverage and benefits, like a health savings account (HSA) or COBRA?
• Does your employee health insurance provide creditable drug coverage?
• How much comes out of your paycheck for employee-sponsored health insurance?

Compare the healthcare benefits and costs of your employee plan and Medicare coverage to make an informed decision. If you delay enrollment until retirement, you’ll need to sign up within the 8-month Special Enrollment Period (SEP) after your workplace health coverage ends. 

When you decide to enroll in Medicare, know that Medicare Part A and Part B may not cover all your healthcare costs, especially if you have chronic conditions or unique health needs. Many people add a private Medicare plan for extra coverage.

Understanding the role of private Medicare coverage

If you want additional coverage or help with out-of-pocket and drug costs, consider a private Medicare plan. The three main options are outlined below:

Medicare Supplement plan

Medicare Supplement plans, also called Medigap, are offered by private insurance carriers to complement Medicare Part A and/or Part B. These 10 standardized plans help cover out-of-pocket costs that Original Medicare doesn’t pay for. Some Medigap plans also include coverage for services that aren’t provided by Medicare, such as emergency medical care while traveling abroad. 

Medicare Part D

If you’re interested in prescription drug coverage, you can enroll in Medicare Part D. It’s offered as a stand-alone option with Original Medicare or bundled into a Medicare Advantage plan. Part D’s annual out-of-pocket max ($2,100 in 2026) helps control costs for both generic and brand-name medications. 

Medicare Advantage 

Medicare Advantage (MA-PD) offers a simplified alternative to managing multiple Medicare plans. Instead of enrolling in Original Medicare and separate supplemental or drug coverage, you can receive these benefits through a single, all-in-one plan. Also referred to as Medicare Part C, these private plans combine Parts A, B, and D and may include dental, vision, or hearing coverage. 

Since all private Medicare plans will vary by carrier, it’s important to review specific plans and weigh them against your healthcare needs to ensure you receive the right level of coverage.

Medicare costs for working seniors and retirees

Whether you have Original Medicare or private Medicare coverage, you can expect to pay a monthly premium, an annual deductible, and copays or coinsurance for health services when working and retired. The only exception is Part A, which is premium-free if you’ve worked and paid Medicare taxes for at least 10 years.

You may wonder, “Why are senior citizens paying for Medicare when they already paid taxes when they worked”? In simple terms, the Medicare tax you paid while working only covers Part A, and Medicare premiums and other payments help cover the remaining costs for you and others on Medicare. 

If you work while enrolled in Medicare, you still need to pay the 1.45% Medicare tax on earned income. Keep this cost in mind when planning for retirement and Medicare enrollment.

Preparing for Medicare enrollment? We can help

If you still have questions about Medicare for working seniors,  here to help. Our licensed insurance agents can help you understand your coverage needs, explore private Medicare plans, and ensure you feel confident about your Medicare decisions. Connect with an agent today.

*Disclaimer:

The information provided in this blog post is intended for general informational purposes only and does not constitute medical advice. It is not a substitute for professional medical consultation or treatment. Always consult with a qualified healthcare provider for any questions you may have regarding a medical condition.

SmartMatch does not endorse or recommend any specific products, treatments, or procedures mentioned in this article. Reliance on any information provided in this blog post is solely at your own risk. We encourage you to discuss any health concerns or questions with your doctor before making any decisions about your health or treatment.