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Medicare Course/Module 8 of 12·15 min

Working past 65 — when to defer Medicare and when not to

The 20-employee rule, COBRA traps, HSA timing, the 8-month return SEP

In this module

If you're still working at 65 with employer coverage, you can usually defer Medicare safely. But there are three traps that catch people: the 20-employee rule, COBRA, and HSA contributions. Here's the safe playbook.

The 20-employee rule

If your employer (or your spouse's employer if you're on their plan) has 20 or more employees, the employer plan is PRIMARY and Medicare is SECONDARY. You can safely defer Medicare and use the employer plan as your main coverage. No late penalty when you eventually enroll.

If your employer has FEWER than 20 employees, Medicare is PRIMARY and the employer plan is SECONDARY. In this case, you MUST enroll in Medicare at 65, even if you have employer coverage. The employer plan won't fully cover what Medicare would pay because Medicare is primary by law.

This is the single most important question to ask: is my employer of 20+ employees, or under 20? If under 20, defer is not an option.

Should you take Part A even if you defer Part B?

Most people take Part A at 65 even while working — because for most, Part A is premium-free (40+ quarters). Taking premium-free Part A doesn't conflict with employer coverage and gives you hospital backup if something happens.

BUT — and this is critical — if you contribute to an HSA, you CANNOT contribute while enrolled in any part of Medicare. Enrolling in Part A (or any other part) ends your HSA contribution eligibility starting the month you enroll.

Even worse: if you're already collecting Social Security and you delay Medicare, you'll be auto-enrolled in Part A retroactively up to 6 months when you do sign up. So you can't truly 'just enroll later' in Part A if SS is involved.

Practical rule: if you're maximizing HSA contributions in your last working years, you may want to defer Part A and not collect Social Security until you stop contributing to the HSA.

The COBRA trap

When active employment ends and you elect COBRA: COBRA is creditable for Part D (no Part D penalty), but COBRA is NOT creditable for Part B (you can still get Part B late penalty).

Your 8-month Part B Special Enrollment Period begins the day active employment ends — not when COBRA ends. So if you elect 18 months of COBRA, your SEP closes after 8 months and you're stuck waiting for the next GEP.

Practical move: if you're laid off or retire and elect COBRA, enroll in Part B IMMEDIATELY (or within the 8-month window). Don't let COBRA give you a false sense of being 'covered.'

Form CMS-L564 — your evidence of coverage

When you enroll in Part B during the working-past-65 SEP, you'll need Form CMS-L564 — the 'Request for Employment Information.' Your employer fills out the dates of coverage and attests to it. Required documentation for SEP enrollment.

Get this form from SSA or download from cms.gov. Fill out Section A. Have the employer fill out Section B. Submit with your Part B enrollment application.

If your employer is gone (acquired, bankrupt, no HR), you can still document creditable coverage with pay stubs, insurance cards, ID cards, anything that shows continuous coverage. The bar is documentation, not specifically the form.

The 8-month return SEP

When active employment ends (job loss, retirement, leaving the company), you have 8 months to enroll in Part B without penalty. The 8 months starts the day your group coverage ends OR active employment ends, whichever is FIRST.

Most people don't wait the full 8 months. They enroll the month before coverage ends to avoid gaps. The SEP is a buffer, not a target.

If you miss the 8 months: GEP only. Late penalty applies. Avoidable but real.

Self-employed past 65

If you're self-employed at 65 and have your own individual health insurance: that doesn't count as 'creditable coverage' for Part B in the way employer group coverage does. You should enroll in Part B at 65 unless you have a specific group plan (some self-employed people via SHOP exchanges or trade associations have group coverage, which may qualify).

Self-employed scenarios get individualized. If you're a sole prop with an individual ACA plan, defer is risky. If you're an S-corp owner with a small group plan, you may be OK depending on the group size.

When in doubt: enroll in Part B at 65 and use Original Medicare or MA as your primary. Drop the individual plan or use it as supplemental dental/vision.

Key takeaways
  • 20-employee rule: employer of 20+ = defer is safe. Under 20 = MUST enroll at 65.
  • Part A while working: usually fine, but kills HSA contributions.
  • COBRA isn't creditable for Part B. SEP starts at active employment end.
  • Form CMS-L564 is your evidence-of-coverage proof for SEP enrollment.
  • 8-month Part B SEP after active employment ends. Don't wait.
  • Self-employed: usually no defer unless on a true group plan.
Action steps — do this now
  1. Confirm your employer's headcount in writing. 20+ or under 20?
  2. If on HSA, calendar your last contribution and Medicare enrollment date.
  3. Get CMS-L564 filled out by HR before you leave.
  4. Set Part B enrollment for the month before group coverage ends.
Cheat sheet — Working past 65 decision tree
  • · Employer 20+? → Defer is safe, employer is primary.
  • · Employer under 20? → Enroll Part B at 65, Medicare is primary.
  • · On HSA? → Defer ALL Medicare parts including A to keep contributing.
  • · On COBRA? → Part B SEP starts at active employment end, NOT COBRA end.
  • · Leaving job? → 8-month Part B SEP. Use it.
  • · Self-employed individual plan? → Usually enroll at 65, don't defer.

Print this cheat sheet for quick reference. Pairs with the full lesson above.

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