Medicare 2026

Midvale Guide to Medicare While Still Working at 65

MIDVALE, Utah — Turning 65 used to mean retiring and signing up for Medicare on the same day. Today, plenty of people in Midvale are still on the job at 65, 66, even 70 — and they already have health coverage through work. That raises a very practical question: do you need Medicare too, and if so, when?

The answer depends on the size of your employer, how the two plans coordinate, and a handful of deadlines that can be expensive to miss. Here is a plain-English walkthrough.

First, the size-of-employer rule

Medicare's coordination rules hinge on how many people work at your (or your spouse's) employer.

• 20 or more employees: Your group health plan generally pays first, and Medicare pays second if you enroll. You can usually delay Medicare without penalty because your job-based coverage counts as "creditable."
• Fewer than 20 employees: Medicare typically pays first, and your group plan pays second. In this case, most people need to enroll in Medicare at 65 or risk gaps in coverage, because the employer plan may not pay much until Medicare has paid its share.

If you are not sure which category you fall into, ask your HR or benefits administrator in writing. This one detail changes almost everything else.

Part A is usually the easy call

Most people qualify for premium-free Part A (hospital insurance) because they or a spouse paid Medicare taxes for at least 10 years. If that is you, enrolling in Part A at 65 is often harmless — it can act as secondary coverage for hospital stays.

One important exception: if you contribute to a Health Savings Account (HSA) through work, you (and your employer) must stop contributing once Part A starts. Enrollment in Part A is also backdated up to six months, so plan the timing carefully with your benefits team before signing up.

Part B is where the real decision lives

Part B (doctor and outpatient care) has a monthly premium, so this is the piece most working people weigh carefully.

• If your employer has 20+ employees and the coverage is creditable, you can generally delay Part B and pick it up later using a Special Enrollment Period (SEP) — you get up to 8 months after the job or the coverage ends, whichever comes first.
• If your employer has fewer than 20 employees, delaying Part B can leave you underinsured and hit you with a lifelong late-enrollment penalty (10% added to your premium for each full 12 months you could have had it but didn't).

If your income is above $109,000 as a single filer for 2026, be aware Part B and Part D premiums may include an IRMAA surcharge based on your tax return from two years ago.

Don't forget prescription drugs

Part D (or a Medicare Advantage plan with drug coverage) has its own rules. If your employer's drug coverage is creditable — meaning at least as good as Medicare's — you can delay Part D without penalty. Your plan is required to send you a notice each year telling you whether it is creditable. Save that notice.

For 2027, Medicare drug coverage includes real consumer protections worth knowing about even if you stick with employer coverage today:

• A $2,400 annual out-of-pocket cap on covered drugs in 2027 (it is $2,100 in 2026).
• A maximum Part D deductible of $700 in 2027 (it is $615 in 2026).
• The old coverage gap ("donut hole") is gone as of 2025.
• An optional Medicare Prescription Payment Plan lets you spread drug costs across the year in monthly bills instead of paying big amounts at the pharmacy.

What's available around Midvale

Midvale is in Salt Lake County, where Medicare beneficiaries have access to Original Medicare (Parts A and B) plus a range of Medicare Advantage and stand-alone Part D options offered by private insurers. You can see the current year's plan counts, carriers, and details for your ZIP code using the Plan Finder at medicare.gov. Availability is set at the county level, not by city.

Key deadlines to circle

• Your Initial Enrollment Period runs 7 months — the 3 months before your 65th birthday month, that month, and the 3 months after.
• Special Enrollment Period for people leaving job-based coverage: up to 8 months after employment or the group coverage ends.
• Medicare Annual Enrollment Period: October 15 – December 7 each year.
• Medicare Advantage Open Enrollment: January 1 – March 31 for people already in an Advantage plan.

Missing an enrollment window is one of the most common — and most avoidable — mistakes people make when they work past 65.