Medicare 2026

Why Wausau Workers at 65 Weigh Medicare Timing

WAUSAU, Wis. — Turning 65 while you're still punching a clock brings up a question that trips up a lot of people: Do I sign up for Medicare now, or wait? For workers in Wausau and across Marathon County, the answer depends on the size of your employer, the kind of coverage you have, and how the two programs work together.

Here's a plain-language guide to help you think it through — and where to get personalized help before you decide.

First, know your two "windows"

When you turn 65, you get an Initial Enrollment Period — a seven-month window that starts three months before your birthday month and ends three months after. Most people are automatically enrolled in Part A (hospital) and Part B (medical) if they already get Social Security. If not, you sign up yourself through the Social Security Administration.

If you keep working past 65 and have qualifying employer coverage, you may also qualify later for a Special Enrollment Period to sign up for Part B without a late penalty — up to 8 months after the job or the group coverage ends, whichever comes first.

The employer size question changes everything

This is the single most important factor:

• If your employer has 20 or more employees: Your group health plan is usually the primary payer, and Medicare would be secondary. Many people in this situation delay Part B to avoid paying its monthly premium while they already have solid coverage.
• If your employer has fewer than 20 employees: Medicare is usually the primary payer once you're eligible, and the group plan pays second. In this case, not signing up for Part B could leave you with big gaps, because the employer plan may not pay much until Medicare has paid first.

Ask your HR or benefits office in writing which payer is primary at 65. It's a fair question, and the answer shapes your whole strategy.

Part A is usually a "yes" — with one exception

Most people qualify for premium-free Part A because they (or a spouse) paid Medicare taxes for at least 10 years. Since it costs nothing, many workers enroll in Part A at 65 even if they delay Part B.

The exception: if you contribute to a Health Savings Account (HSA), you can't keep making HSA contributions once you're enrolled in any part of Medicare, including Part A. If your HSA matters to you, talk with your benefits team and a tax adviser before enrolling.

Don't forget prescription drug coverage

If your employer plan includes drug coverage, ask whether it's considered "creditable" — meaning it's at least as good as a standard Medicare Part D plan. Your plan is required to send you a notice each year telling you this.

• If your drug coverage is creditable, you can delay Part D without a late penalty.
• If it isn't, and you go more than 63 days without creditable coverage, you could face a permanent Part D late-enrollment penalty when you sign up later.

A few Part D facts to keep in mind, with 2027 figures where CMS has published them:

• The out-of-pocket cap on covered drugs is $2,100.
• The maximum Part D deductible is $615.
• The old "donut hole" coverage gap is gone — Part D now has three simpler phases.
• The Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments if you'd like.

What's available locally

Wausau is in Marathon County, where Medicare eligibility and plan availability are set at the county level. If and when you're ready to move from employer coverage to Medicare, you'll have Original Medicare (Parts A and B) plus options like a stand-alone Part D drug plan, a Medigap (Medicare Supplement) policy, or a Medicare Advantage plan that bundles coverage together. The number of Advantage and drug plans offered in Marathon County changes each year, so it's worth checking the Medicare Plan Finder at medicare.gov during Annual Enrollment (Oct. 15 – Dec. 7).

A quick income note

If your household income is higher, be aware of IRMAA — an income-related surcharge on Part B and Part D premiums. In 2026, it kicks in above $109,000 for a single filer (higher for joint filers). Social Security uses your tax return from two years earlier to set it.