Health Tips and Information

Turning 65 often brings an important question: do you need to enroll in Medicare if you are already covered under your employer’s health insurance plan? The answer depends on several factors, including the size of your employer and the type of coverage you currently have. Understanding the rules can help you avoid costly penalties and gaps in coverage later.

If you are still actively working and covered by your employer’s group health plan, you may not need to enroll in all parts of Medicare right away. In many cases, people choose to delay Medicare enrollment while they continue working and receiving benefits through their job.

How Large is Your Employer?

One of the biggest factors is the size of your employer. If your company has 20 or more employees, your employer insurance is generally considered primary coverage, and Medicare becomes secondary. In this situation, you can usually delay enrolling in Medicare Part B without facing a late enrollment penalty later. Many people still enroll in Medicare Part A at age 65 because it is often premium-free and can provide additional hospital coverage.

However, if your employer has fewer than 20 employees, Medicare may become your primary insurance once you turn 65. In that case, failing to enroll in Medicare Part A and Part B when first eligible could leave you with unpaid medical expenses. Small employer plans may expect Medicare to pay first, and if you are not enrolled, you could be responsible for costs that Medicare would have covered.

Are You Enrolled in an HSA?

Another important consideration is Health Savings Accounts, or HSAs. If you contribute to an HSA through a high-deductible health plan, enrolling in any part of Medicare can affect your ability to continue making tax-advantaged HSA contributions. Many people choose to delay Medicare enrollment for this reason, but it is important to plan carefully and understand the timing rules.

Are You Covered Under Your Spouse’s Plan? 

Spousal coverage can also impact your decision. If you are covered under your spouse’s active employer plan, the same employer size rules generally apply. Reviewing the details of the plan with a licensed insurance professional or benefits administrator can help clarify your options.

Make the Choice Carefully

The key takeaway is that Medicare enrollment is not always automatic or required at age 65 if you have employer insurance. However, making the wrong choice can lead to lifelong penalties or unexpected healthcare costs. Before deciding whether to delay Medicare, review your employer coverage carefully and speak with one of our knowledgeable Medicare advisors who can help you understand how the rules apply to your specific situation.

Health needs can change at any time, and when they do, your current Medicare plan may no longer fit. Many people assume they are locked into their coverage once the Annual Enrollment Period and the Medicare Open Enrollment Period have passed. The good news is that there are still options available depending on your situation.

Special Enrollment Periods

A Special Enrollment Period, often called an SEP, allows you to make changes to your Medicare coverage outside of standard enrollment windows. These periods are triggered by specific life events.

Common qualifying situations include moving to a new address, losing other health coverage, or becoming eligible for programs like Medicaid. In these cases, you may be able to switch Medicare Advantage plans or update your Part D prescription drug coverage to better match your current needs.

Medicare Advantage Open Enrollment Period

If you’re enrolled in a Medicare Advantage plan, there is an additional opportunity early in the year to make a change. From January 1 through March 31, you can switch to a different Medicare Advantage plan or return to Original Medicare. If you choose to return to Original Medicare, you can also add a Part D drug plan.

This option can be especially helpful if you realize your current plan is not meeting your medical or prescription needs.

Five-Star Special Enrollment Period

Another lesser-known option is the Five-Star Special Enrollment Period. If there is a Medicare plan in your area with a five-star quality rating, you can switch to that plan once per year. This can be a great opportunity to move into a higher-rated plan that may offer better service and coverage.

Changes Based on Financial Assistance

If your financial situation changes and you qualify for programs like Extra Help or Medicaid, you may gain additional flexibility to adjust your coverage. These programs can open the door to more frequent plan changes and reduced out-of-pocket costs.

Why Reviewing Your Coverage Matters

When your health changes, your coverage should keep up. Whether you need different specialists, medications, or treatment options, reviewing your Medicare plan ensures you are not paying more than necessary or missing out on benefits that could better support your care.

Understanding these rules and timelines can feel overwhelming, but you don’t have to navigate them alone.

If your needs have changed and you are unsure what to do next, contact our health insurance brokers. We can walk you through your options, help you compare plans, and guide you toward the best choice for your situation. Best of all, getting help with your Medicare plan is always free of charge.

For those enrolled in a Medicare Advantage plan, time is running out to make changes for this year. The Medicare Advantage Open Enrollment Period ends on March 31, and this is your last opportunity to adjust your coverage until later in the year.

During this enrollment period, individuals who already have a Medicare Advantage plan can make a one-time change. You can switch to a different Medicare Advantage plan that may better fit your needs, or you can return to Original Medicare. If you choose to go back to Original Medicare, you may also have the option to enroll in a standalone Part D prescription drug plan.

This is an important window to review how your current plan is working for you. Ask yourself…

• Are your doctors still in network?
• Are your prescriptions covered the way you expected?
• Have your healthcare needs changed since you first enrolled?

Even small changes in coverage can make a big difference in your out-of-pocket costs and overall satisfaction with your plan.

Many people assume they are locked into their plan for the year, but that is not the case during this period. If something is not working, you still have time to make a change. Waiting until the next enrollment period could mean months of dealing with coverage that does not meet your needs.

It is also important to act soon because plan changes can take time to process. The closer we get to the deadline, the less time there is to review your options and ensure everything is in place for a smooth transition.

The good news is that you do not have to figure this out on your own. As a licensed insurance broker, we can walk you through your options, compare plans, and help you find coverage that fits your doctors, prescriptions, and budget. Best of all, our help is always completely free. There is no cost to you for our guidance and support.

If you have been thinking about making a change or even if you just want a second opinion on your current plan, now is the time to act. Don’t wait until the deadline passes and miss your opportunity.

Call us right away to review your Medicare coverage and get the help you need before the March 31 deadline.

A new year often brings fresh plans and big decisions, and for many retirees, relocating is one of them. Whether you’re considering a move to be closer to family, downsizing, or seeking a lower cost of living, planning ahead is essential. If a move is on your horizon in 2026, it’s especially important to understand how your Medicare coverage may be affected and what steps you can take now to avoid surprises later.

Why Moving Matters for Medicare

Your Medicare coverage is tied to where you live. While Original Medicare (Part A and Part B) works nationwide, Medicare Advantage and Part D prescription drug plans are location-specific. These plans are built around regional provider networks, hospitals, and pharmacies. A move, even within the same state, can mean your current plan is no longer available or no longer the best fit for your healthcare needs.

If you relocate to a new service area, you’ll typically qualify for a Special Enrollment Period (SEP). This allows you to change Medicare Advantage or Part D plans outside of the standard enrollment windows. Planning ahead helps ensure you don’t experience gaps in coverage or lose access to your preferred doctors and prescriptions.

Steps to Take Before You Move

If you’re thinking about moving in 2026, start by reviewing your current Medicare plan. Ask yourself whether your doctors, specialists, and hospitals would still be accessible in your new location. It’s also wise to consider how your healthcare needs may change as you age and whether your current plan will continue to support those needs.

Next, research Medicare Advantage and Part D plans available in the area you’re considering. Premiums, out-of-pocket costs, provider networks, and drug formularies can vary widely by location. Comparing plans ahead of time allows you to make a smooth transition when the move happens.

Timing Is Everything

Your move triggers a limited window to make changes, so understanding the timing rules is critical. In many cases, you can begin shopping for new Medicare plans before your move and finalize your selection shortly after your relocation. Missing these deadlines could mean waiting until the next Annual Enrollment Period to make changes, potentially leaving you with coverage that doesn’t work for you.

Get Expert Help

Planning a move is stressful enough; your Medicare coverage shouldn’t add to the burden. Our insurance brokers specialize in Medicare plans and enrollment and can help you plan ahead with confidence. We’ll review your options, explain how a move impacts your coverage, and help you choose a plan that fits your new location and healthcare needs.

If a move is part of your 2026 plans, contact our insurance brokers today for personalized guidance. Planning ahead now can save you time, money, and headaches later.

If you enrolled in a Medicare Advantage plan during the Annual Election Period and now you’re second-guessing your choice, or if you missed AEP altogether, you still have one more opportunity to make a change. Medicare Advantage Open Enrollment exists for this exact reason. It gives you a final chance to review your coverage and make corrections if your plan is not meeting your needs.

Medicare Advantage Open Enrollment runs from January 1 through March 31 each year. During this time, people who are already enrolled in a Medicare Advantage plan can make one change. That change can be switching to a different Medicare Advantage plan or leaving Medicare Advantage and returning to Original Medicare. If you return to Original Medicare, you also have the option to apply for a Part D prescription drug plan and, in many cases, a Medicare Supplement policy.

This enrollment period is especially important if you realized that your plan does not cover your doctors, prescriptions, or preferred hospitals, or if your out of pocket costs are higher than you expected. Many people choose a plan during AEP based on limited information or marketing materials that do not fully explain provider networks and drug formularies. Once you begin using the plan in January, the gaps often become clearer.

If you missed the Annual Election Period entirely, Medicare Advantage Open Enrollment may also be your only chance to make a change this year, as long as you are already enrolled in a Medicare Advantage plan. For most beneficiaries, this is their one and only opportunity to correct a mistake or adjust their coverage until the next Annual Election Period in the fall.

It is important to understand that this enrollment period does not allow unlimited changes. You can only make one change, so it is critical to review your options carefully before you submit an application. You will want to look at your doctors, prescription medications, travel habits, and overall health needs to be sure the new plan is truly a better fit.

If you’re confused or worried about making the wrong choice again, help is available. A licensed health insurance broker can review your current plan, compare it to other options in your area, and explain the differences in plain language. This guidance is free and can save you from costly mistakes.

If you think your Medicare Advantage plan is not right for you, or if you missed AEP and want to know what options you still have, don’t wait! Medicare Advantage Open Enrollment ends March 31, and for most people, it is the last chance to make a change this year. Reach out to us now and make sure your coverage truly supports your health and your budget.