If you’re turning 65 but your spouse is still working and you’re covered under their employer insurance, you’re probably wondering:

“Do I need to enroll in Medicare now, or can I wait?”

It’s one of the most common — and most confusing — Medicare questions out there.

Let’s break it down clearly so you can make the best decision for your situation.

The Common Assumption

Many people believe that as long as they have coverage through a working spouse, they don’t need to do anything with Medicare.

That’s partially true — but only if certain conditions are met.

If your spouse’s employer has 20 or more employees, you may be able to delay Medicare Part B (and avoid paying for it unnecessarily).

If the employer has fewer than 20 employees, you likely need to enroll in Medicare Parts A and B when you turn 65 — even if your spouse’s plan still covers you.

Why the Size of the Employer Matters

Medicare’s coordination of benefits rules determine who pays first — Medicare or the employer plan.

• Large Employer (20+ employees) → Employer plan pays first, Medicare pays second.

• Small Employer (under 20 employees) → Medicare pays first, and the employer plan pays second.

If you’re on a small employer plan and you don’t have Medicare Part B, the employer plan may refuse to pay what Medicare would have covered — leaving you with large out-of-pocket bills.

Questions to Ask Before Making a Decision

Before you delay or enroll, ask your spouse’s HR or benefits department these key questions:

1. Is our employer plan creditable coverage for Medicare?

2. Is this plan considered primary or secondary to Medicare?

3. What happens to my coverage once I turn 65?

4. Will I lose coverage or face higher costs if I enroll in Medicare?

Get the answers in writing if possible.

Not every HR department fully understands Medicare rules, especially in small organizations.

What Happens When Your Spouse Retires

This is where timing becomes critical.

Once your spouse retires, your access to their employer plan ends — and so does your Special Enrollment Period (SEP) window to sign up for Medicare Part B without penalty.

You’ll typically have 8 months from the end of active employment to enroll in Part B.

(That clock doesn’t start when COBRA begins — it starts when your spouse stops working.)

Miss that window, and you could face:

• A lifetime penalty on your Part B premium

• Delayed coverage

• Months without insurance

A Real-Life Example

A client’s husband continued working at a large hospital after she turned 65, so she stayed on his employer plan.

When he retired two years later, they assumed COBRA would protect her until she switched to Medicare.

Unfortunately, COBRA isn’t considered creditable coverage for delaying Part B.

She missed her 8-month SEP window and had to wait months for her coverage to start — paying out of pocket in the meantime.

What You Can Do Now

1. Confirm the employer’s size.
   
   The number of full-time employees determines which rules apply.

2. Ask for a “Creditable Coverage” letter for both medical and prescription benefits.

3. Plan your timeline.
   Don’t wait for retirement to figure it out — start at least 3–6 months before turning 65.

4. Work with a licensed broker.
   A broker can confirm how your spouse’s plan coordinates with Medicare and help you avoid penalties or gaps.

The Bottom Line

If your spouse is still working, you might be able to delay Medicare — but don’t assume it’s automatic.

The rules depend on employer size, coverage type, and how your plan coordinates with Medicare.

At Mere, we help couples navigate these tricky timelines so you never pay for duplicate coverage — or go without protection.

📞 Call 904-654-5450 or visit www.merebenefits.com to schedule a no-cost consultation and find the right Medicare timeline for you and your spouse.

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