Medicare 2026

Medicare and employer coverage in Florissant while working

FLORISSANT, Mo. — Turning 65 while still on the job used to be rare. Today it's common, and it raises a real question: do you sign up for Medicare, stay on your employer plan, or somehow do both? The answer depends on the size of your employer, how your coverage is built, and a few deadlines you don't want to miss.

Here's a plain-language guide to how Medicare coordinates with job-based coverage as you weigh 2027 choices — and where Florissant workers can go for personalized help.

First, know which coverage pays first

When you have Medicare and other insurance, one is the "primary payer" (pays first) and the other is "secondary." This isn't optional — Medicare's rules decide the order.

• Employer with 20 or more employees: Your group health plan pays first, and Medicare pays second.
• Employer with fewer than 20 employees: Medicare generally pays first, and your group plan pays second.

That second rule matters a lot. If you work for a small employer and you don't enroll in Medicare when you're first eligible, you could end up with big bills the group plan won't cover — because it expected Medicare to be primary.

Do you have to sign up for Medicare at 65?

Not always. If you (or your spouse) are still working and covered by a large employer's group health plan, you can usually delay Part B without a late penalty. When the job or the coverage ends, you get an eight-month Special Enrollment Period to sign up for Part B without penalty.

But there are exceptions worth knowing:

• Small employer? Enroll in Parts A and B at 65 to avoid coverage gaps.
• Retiree coverage or COBRA? These do not count as "active" employer coverage. Delaying Part B while on COBRA or retiree insurance can trigger a lifelong late-enrollment penalty.
• High-deductible plan with an HSA? Once you enroll in any part of Medicare (including Part A), you can no longer contribute to your HSA. Many workers stop HSA contributions a few months before enrolling.

Part A is usually a yes — Part B is the real decision

Most people qualify for premium-free Part A (hospital insurance) based on their work history, so enrolling at 65 often costs nothing out of pocket. Some people delay even Part A if they want to keep contributing to an HSA.

Part B (doctor visits, outpatient care) has a monthly premium. That's where the "keep it or delay it" math happens. Compare what you'd pay for Part B against what your employer plan covers — and remember that if your income is above $109,000 for a single filer in 2026, an IRMAA surcharge is added to your Part B and Part D premiums.

What about drug coverage (Part D)?

If your employer plan includes prescription drug coverage that Medicare considers "creditable" (at least as good as standard Part D), you can delay Part D without penalty. Your plan should send you a notice each year confirming this — keep it.

A few Part D facts worth knowing for 2027, whether you enroll now or later:

• The out-of-pocket cap is $2,100 for the year.
• The maximum deductible is $615.
• The old "donut hole" is gone — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread drug costs into monthly payments instead of paying big bills at the pharmacy counter.

Coverage choices in the Florissant area

Florissant is in St. Louis County, where Medicare beneficiaries have a wide range of Original Medicare, Medigap, Part D, and Medicare Advantage options to consider once they do leave employer coverage. Plan availability is set at the county level, so two neighbors in the same ZIP code see the same menu of choices.

Keep these dates in mind:

• Oct. 15 – Dec. 7, 2026: Medicare Annual Enrollment Period (change Part D or Advantage plans for 2027).
• Jan. 1 – March 31: Medicare Advantage Open Enrollment (for people already in an Advantage plan).
• Your 8-month Special Enrollment Period: starts the month after your job or group coverage ends.