So You're Turning 65...

When you’re within 90 days of your 65th birthday, your mailbox likely feels like it’s under siege. Between the colorful brochures and the "URGENT" notices, there is one question that most working professionals struggle with: "Should I keep my employer’s insurance or switch to Medicare?"

While many assume staying on a company plan is the "easier" path, that convenience can sometimes come with a hidden price tag. Here is a guide on what to look out for when weighing your options.

1. The "Company Size" Rule (The 20-Employee Threshold)

One of the most critical factors is the size of the company you (or your spouse) work for.

• Large Employers (20+ Employees): Usually, your employer insurance remains "primary." You can often delay Medicare Part B without penalty.

• Small Employers (Fewer than 20 Employees): This is a major "watch out" area. In many cases, Medicare becomes the primary payer the moment you turn 65. If you don't enroll in Part B, your employer insurance may refuse to pay their portion of a bill, leaving you with a massive financial gap.

  
  

2. The HSA "Stop Sign"

If you love your Health Savings Account (HSA), proceed with caution. Once you enroll in any part of Medicare (even just the premium-free Part A), you can no longer contribute to an HSA.

• The Trap: If you enroll in Medicare after age 65, your Part A coverage can be backdated up to six months. To avoid tax penalties, most experts recommend stopping HSA contributions at least six months before you plan to apply for Medicare or Social Security.

  
  

3. Comparing the "Total Cost of Care"

It’s easy to look at your monthly payroll deduction and think your work plan is cheaper. But to get a true "apples-to-apples" comparison, you have to look deeper:

• The Deductible: Many modern employer plans have high deductibles ($3,000–$5,000+). Many Medicare paths offer $0 or very low deductibles.

• The Network: Employer plans often use restrictive HMO or PPO networks. With Original Medicare and a Supplement, you can see any doctor in the U.S. who accepts Medicare.

• The "Extras": Does your employer plan cover dental, vision, and hearing? If not, a Medicare Advantage plan might actually offer more benefits for a lower combined cost.

  
  

4. The Spouse & Dependent Factor

Medicare is individual—there is no "family plan." If you switch to Medicare but your younger spouse or children rely on your employer's plan for coverage, your departure could trigger a "qualifying event" for them. You’ll need to ensure they have a bridge to their own coverage before you make the leap.

5. Creditable Coverage & Late Penalties

If you decide to stay with your employer, you must ensure your prescription drug coverage is "creditable" (meaning it's at least as good as Medicare Part D). If it isn't, and you try to switch to Medicare later, you could be hit with a lifetime late-enrollment penalty. Always keep the annual "Notice of Creditable Coverage" your HR department sends out.

The "Medicare vs. Employer" debate isn't about which system is better in general—it’s about which one is better for your specific health needs and budget.

At getMcare, we specialize in helping those approaching 65 cut through the confusion. Our core belief is to help in educating our community within the Medicare world. We can help you perform a Side-by-Side Analysis where we look at your current employer benefit summary and compare it directly to the Medicare options available in your area.

Whether you decide to stay with your company plan for a few more years or make the switch to Medicare today, we’re here to ensure you make that choice with total confidence.

Would you like to see how your current plan stacks up? Schedule a sit down for a no-strings attached hour session with one of our trusted, licensed agents.