Today, the number of people 65 and older who continue to work might surprise you. According to the Bureau of Labor and Statistics, more than one in four people in the 65-to-74 age bracket participated in the civilian workforce in 2020. By 2030, the workforce participation rate is expected to increase to nearly one in three. This leads to an important question: Do you have to get Medicare when you turn 65?

Many people approaching age 65 often ask whether it is mandatory to sign up for Medicare. You need to be aware of some possible premium penalties if you miss specific signup dates. But if you plan to keep working or have employer health coverage through a spouse, the following guide gives you essential information as you approach your 65th birthday.

Do You Have to Get Medicare When You Turn 65 if You Have Employer Coverage? Ask This Important Question.

Does your employer have 20 or more employees? This question is the key to figuring out your next step.

CMS says that most people should enroll in Medicare Part A when they first become eligible at 65, even if they have employer-sponsored insurance. This is because most people do not pay a premium for Medicare Part A. However, there is a premium for Medicare Part B, and people who have qualifying group health insurance through their or their spouse’s current employment may be able to delay Medicare enrollment without incurring a late penalty.

But proceed carefully! Not all plans qualify for penalty-free late enrollment. If the employer has fewer than 20 employees, CMS says that you should enroll in Medicare Parts A and B when you turn 65. Also, plans that are not based on current employment, such as COBRA and plans purchased on the Health Insurance Marketplace, will not qualify you for penalty-free late enrollment or a Special Enrollment Period. As a result, you may end up paying more, and you may also have a gap in your coverage. Talk to your health plan administrator before deciding.

Can I Have Medicare and Employer Coverage?

Instead of choosing between Medicare and employer coverage, you may decide to have both. This can be possible, but you need to understand how your two plans will coordinate.

If you work for an employer with 20 or more employees, your employer-sponsored group health plan is the primary payer and Medicare is the secondary payer. If the employer has fewer than 20 employees, Medicare is the primary payer, and the group health plan is the secondary payer. The primary payer always pays first, and the secondary payer pays costs that the primary payer doesn’t cover, up to the coverage limits.

What if I Have a High Deductible Health Plan and an HSA?

If you have an HSA and are nearing Medicare eligibility, understand how Medicare works when you have an HSA. HSAs are designed to work with high-deductible plans, and only people who are enrolled in high-deductible plans can make contributions. If you enroll in Medicare, you can no longer contribute to your HSA. However, you may continue to take money from your HSA while enrolled in Medicare to help pay for medical expenses, like deductibles, premiums, copayments and coinsurance.

If you would like to continue making contributions to your HSA, you may be able to delay your enrollment in Medicare. However, you need to watch out for possible late enrollment penalties and coverage gaps, as discussed above. Also, if you are receiving Social Security benefits, you will be enrolled in Medicare automatically when you turn 65, and this will make you ineligible for HSA contributions. Finally, beware of Medicare’s six-month lookback period, which provides retroactive coverage. The Journal of Accountancy suggests ending HSA contributions six months before starting Medicare in order to avoid penalties.

What if I Have Marketplace Insurance or Private Insurance Not Offered by an Employer?

If you have a Health Insurance Marketplace plan through Obamacare, premium subsidies and cost-sharing will end when you enroll in Medicare. Also, enrollment in a Marketplace plan does not qualify you for penalty-free late enrollment in Medicare. Therefore, it makes sense for most people to drop their Marketplace coverage and enroll in Medicare when they become eligible. For detailed instructions on dropping your Marketplace plan, see

What if I Have COBRA Insurance?

COBRA and Medicare coordinate, depending on which form of insurance you have first. It is possible to get COBRA if you already have Medicare, but it is not possible to keep COBRA if you have it before you become Medicare-eligible. It usually ends on the date you get Medicare.

Note that COBRA does not qualify you for a Special Enrollment Period or penalty-free late enrollment. To avoid late enrollment penalties and coverage gaps, you should enroll in Medicare. There is good news: your spouse and dependents may keep COBRA coverage for up to 36 months, regardless of your enrollment status in Medicare.

What if I Have TRICARE, CHAMPVA or VA Insurance?

If you are eligible for premium-free Medicare Part A – and most people are – you will need to enroll in both Medicare Part A and Part B when you become eligible. Otherwise, you may lose your TRICARE or CHAMPVA coverage.

When you have both CHAMPVA and Medicare, the U.S. Department of Veterans Affairs says that CHAMPVA is always the secondary payer. When you have TRICARE and Medicare, Medicare says that TRICARE is the primary payer if you are on active duty or if you’re getting care from a military hospital or other federal healthcare provider.

If you are covered through the VA and are eligible for Medicare, the VA itself recommends that you enroll in Medicare. This way, you’ll be covered when you get care from non-VA providers, and you won’t have to worry about the Medicare late enrollment penalty or possible coverage gaps.

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We’ve answered the question “do you have to get Medicare when you turn 65?” Do you have more questions about retirement? Silver&Smart keeps you up to date on current events, whether you are thinking about planning for retirement costs, traveling, or taking up new hobbies. This information hub keeps you on the cutting edge of new opportunities.

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*This information is for educational purposes only. Each person’s situation and circumstances may vary. We recommend that you speak with a Medicare Insurance agent for guidance related to your personal circumstances.