Still Working After 65? Here’s How Medicare Really Works With Your Insurance

If you’re turning 65 but still working—or covered by a spouse’s job-based health insurance—you might be wondering…

“Do I still need Medicare?”

Great question! The answer? It depends.
And knowing the difference between primary and secondary insurance could save you hundreds (or thousands) in medical bills.

Let’s break it down together.

How Medicare Works With Employer Health Plans

Many people 65+ still have health insurance through an employer (or their spouse’s employer). That’s completely fine—but Medicare wants to know who’s paying the bills first.

This is called “Coordination of Benefits.”

Here’s the Rule of Thumb:

  • If the employer has fewer than 20 employees→ Medicare pays first, your group plan pays second.

  • If the employer has 20 or more employees→ Your group plan pays first, Medicare pays second.

Real-Life Scenarios

Let’s say you’re 65, still working, and your company has 15 employees:
You should enroll in Medicare Part B—because Medicare is your primary insurance.
If you don’t, you could be stuck with medical bills your employer plan won’t cover.

But if your employer has 50 employees?
You can delay Part B (and save money on the premium) because your job-based insurance pays first.

What About Medicare Part D (Drug Coverage)?

Even if you delay Part B, you don’t want to miss the window for drug coverage.
If your employer’s plan already includes prescription benefits that are “creditable” (equal to or better than Medicare Part D), then you’re safe.

But if not? You could face a lifetime penalty if you sign up late.

Special Rules to Know

  • Have ESRD (End-Stage Renal Disease)? Your group plan pays first for 30 months, then Medicare takes over.

  • Got hurt at work or involved in a car accident? Other coverage (like workers’ comp or no-fault insurance) usually pays first.

  • Covered under COBRA? Medicare does not consider COBRA creditable for Part B or Part D.

Bottom Line:

Choosing the right time to enroll in Medicare can be confusing, but it doesn’t have to be.

Still unsure what’s best for your situation?
Talk to a licensed agent today—we’ll help you make the smart (and safe) decision for your healthcare.

✅ Schedule Your Free Medicare Check-Up Now
✅ See If You Can Delay Part B Penalty-Free
✅ Learn If Your Employer Plan is “Creditable”

Let’s make Medicare easy—together.