The 20-employee rule
| Your coverage at 65 | Who pays first | Need Part B now? |
|---|---|---|
| Your or your spouse's current job, employer with 20 or more employees | Job-based plan | No, you can usually delay |
| Your or your spouse's current job, employer with fewer than 20 employees | Medicare | Usually yes |
| COBRA, retiree coverage or a Marketplace plan | Medicare | Yes |
Ask your employer's benefits office, in writing, whether its plan pays first for workers 65 and older and whether it expects you to enroll in Medicare. A small employer's plan may pay only after Medicare, leaving large bills if you don't have Part B.
Signing up later without a penalty
- Plan ahead. Apply a month or two before your job coverage ends so Part B starts the day after.
- Get form CMS-L564 from your employer. It shows the dates of your group coverage from current work.
- Submit form CMS-40B with it. Online, by fax or mail, or at a Social Security office.
- Choose your other coverage. You have 2 full months after job coverage ends to join a Medicare Advantage or Part D plan. Your Medigap open enrollment starts with your Part B and lasts 6 months; North Carolina has no birthday rule, so don't let it pass.
If you miss the 8-month window, you'll wait for the General Enrollment Period (January 1 to March 31) and may pay 10% more for Part B for each full 12 months without it, usually for life. Keep your employer's yearly creditable drug coverage notices, too, to avoid a Part D penalty.
North Carolina public employees and service members
- State employees and teachers: the State Health Plan pays first while you're actively working, and it recommends enrolling in Part A at 65 and delaying Part B. When you retire, the Plan says Parts A and B should be in effect by your retirement date; otherwise you're placed on the 70/30 Plan. See State Health Plan retirees and Medicare.
- Local government employees: your active plan follows the 20-employee rule. Retiree health coverage for LGERS retirees, if any, depends on your former employer, so ask before you retire.
- Active duty at Fort Bragg, Camp Lejeune or another base: TRICARE says you don't need Part B while on active duty, and you get a special enrollment period. Sign up before you leave service, because TRICARE For Life requires Part A and Part B. See military, veterans and TRICARE in North Carolina.
More on working past 65. To review options when you retire, you can request a call from a licensed insurance agent.
Related questions
What if I miss my enrollment period?
Penalties and your next chance.
How do I sign up for Medicare in North Carolina?
Online, by phone or in person.
When should I sign up if I'm turning 65?
Your 7-month window.
Sources
- Medicare.gov — Working past 65
- Medicare.gov — Which insurance pays first?
- Social Security — Apply for Part B during a special enrollment period
- State Health Plan — Retiree presentation (working past 65, retiring at 65 or older)
- NC Retirement Systems — Health benefit coverage for other retirement systems (LGERS)
- TRICARE — Medicare for active duty service members
More questions in this guide
- Can I get Medicare before 65 in North Carolina?
- How do I sign up for Medicare in North Carolina?
- What are the Medicare deadlines in North Carolina for 2027?
- What happens if I miss my Medicare enrollment period in North Carolina?
- When should I sign up for Medicare if I'm turning 65 in North Carolina?
Part of the guide: Medicare enrollment periods in North Carolina · All questions
Frequently asked questions
Should I take Part A while I'm still working?
If it's premium-free, many people do, because it can help as secondary hospital coverage. But if you contribute to a health savings account, Medicare.gov says to stop contributions 6 months before you apply for Medicare or Social Security, since Part A can be backdated up to 6 months.
What forms do I need to sign up for Part B later?
Form CMS-40B, the Part B application, and form CMS-L564, which your employer completes to show your group coverage from current work. You can submit them online at ssa.gov, by fax or mail, or at a Social Security office.
I work for the State of North Carolina. Do I need Part B at 65?
Not while you're actively working with State Health Plan coverage: the Plan is primary for active employees, and it recommends enrolling in Part A and delaying Part B. Sign up for Part B before you retire, because the Plan's retiree Medicare Advantage options require Parts A and B.
Medicare in your North Carolina county
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