As you approach your 65th birthday, one of the most important healthcare
decisions you may face is whether to keep your employer-sponsored health insurance or transition to Medicare . This decision isn’t always straightforward, and the right choice depends on your unique circumstances, including your employment status, current coverage, and healthcare needs.
In this guide, we’ll walk you through the key considerations to help you make an informed, confident choice. Our goal is to be warm, clear, and
supportive—so you can make the decision that’s right for you.
1. Size of Your Employer and Medicare Requirements
The number of employees at your workplace determines how Medicare
coordinates with your employer insurance.
- If your employer has 20 or more employees , your employer insurance is typically primary, and Medicare is secondary .
- If your employer has fewer than 20 employees , you’re usually required to enroll in Medicare Part A and Part B because Medicare becomes your primary insurance .
Why it matters: Failing to enroll in Medicare on time when it’s required could result in penalties or a lapse in coverage.
2. Cost Comparison: Premiums and Out-of-Pocket Expenses
When deciding between employer coverage and Medicare, it’s essential to compare not just premiums but total healthcare costs:
- Monthly premiums (for you and a spouse, if applicable)
- Deductibles, copays, and coinsurance
- Prescription drug costs
- Maximum out-of-pocket limits
Medicare Advantage and Medigap plans often provide affordable
alternatives, especially if your employer plan is costly or has high deductibles.
3. Prescription Drug Coverage
Does your employer plan offer creditable prescription drug coverage (as good as or better than Medicare Part D)? If not, and you delay enrolling in a Part D plan, you could face late enrollment penalties when you do sign up later.
Check with your HR department or plan administrator to verify whether your
drug coverage is creditable.
4. Spousal and Dependent Coverage
If your employer health plan covers your spouse or dependents, you’ll need to think carefully before switching to Medicare. Medicare only covers
individuals, not family members.
You might choose to stay on your employer plan longer if your spouse isn’t eligible for Medicare and would otherwise lose coverage.
5. Health Needs and Provider Access
Consider your current and anticipated healthcare needs:
- Do you have chronic conditions or see specialists regularly?
- Are your doctors in-network for Medicare Advantage plans?
- Do you want nationwide provider access (available with Original
Medicare + Medigap)?
If your employer plan limits access or doesn’t meet your needs, Medicare might provide more flexibility.
6. Flexibility and Future Changes
Medicare offers annual opportunities to switch plans during the Open
Enrollment Period (October 15 – December 7) Your employer coverage may not provide the same flexibility.
Also, if you’re planning to retire in the near future, transitioning to Medicare
now may make sense.
7. Timing Your Enrollment to Avoid Penalties
If you delay Medicare Part B because you have creditable employer coverage, you won’t face a penalty. But once you retire or lose that coverage, you have 8 months to enroll in Part B under a Special Enrollment Period (SEP).
Missing this window could result in a lifetime penalty and delays in coverage.
Final Thoughts: Making the Right Choice for Your Life
Choosing between employer coverage and Medicare isn’t a one-size-fits-all decision. The right path depends on your job, your health, your family, and
your finances. What matters most is having a plan that helps you feel secure, supported, and in control of your healthcare.
If you’re unsure, consider speaking with:
- Your HR or benefits administrator
- A licensed Medicare advisor
- Your local State Health Insurance Assistance Program (SHIP)
There’s no need to rush. With the right information and guidance, you’ll be able to make the choice that feels right for you.
I don’t want to Sign Up for Medicare. Can’t I just keep my employer coverage?
Maybe, if your employer has over 20 employees you can delay signing up, if not you have to sign up or get a penalty.
How do I know which is better, my employer plan or Medicare?
You have to do a comparison between your payroll
deduction/deductibles/Copays to a suitable Medicare Health Insurance Plan.
Can I sign up for Medicare and keep my employer coverage?
Yes but you would want to delay signing up for Part B which carries a monthly premium and just sign up for Part A which for most people is Free.
Mike Miligi- Owner- Michael M Insurance Services
For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in
understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental
and Vision programs. Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs.
Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options. Mike
recertifies with CMS (The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by
individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.
