A physician’s career is built on knowledge, experience, and careful decision-making. But as you approach age 65, a different kind of decision is ahead—one that isn’t about patient care but about protecting your own health and finances.
If you plan to continue practicing beyond age 65, you’re not alone. Many physicians continue working because they love what they do, value the relationships they’ve built, or want to maintain a strong income. Others may be preparing for retirement, but whatever your plans, Medicare decisions and enrollment shouldn’t be delayed. Waiting too long or making the wrong choice could lead to costly penalties that last the rest of your life.
Medicare Enrollment: What You Need to Know
If you are approaching your 65th birthday or you are older than 65, currently working and covered under a creditable group health insurance plan covering over 20 employees, you can elect to delay enrolling in Medicare without penalty. Just know that individual coverage, VA coverage, any retiree or coverage from a former employer as part of a severance or layoff package and COBRA does not qualify as eligible group coverage. However, COBRA does typically count as creditable prescription drug coverage.
Another pre-enrollment consideration is in regard to a Health Savings Account (HSA). Once you enroll in Medicare, you will not be able to make contributions to your HSA. To avoid a tax penalty, you should make your last HSA contribution the month before your Medicare Part A coverage begins.
How Practice Size Affects Medicare Enrollment
Your Medicare decisions depend on the size of your practice and whether you continue employer-based coverage, as the size of your organization can affect your enrollment requirements:
- If you work with more than 20 employees, and your coverage is provided through your employer or your spouse’s plan, you have the option to keep your group coverage and work past age 65 with no penalty. However, once you leave your employer and no longer have group coverage, you must enroll in Medicare Parts A and B during your “Special Enrollment Period” to avoid lifetime penalties. At that time, many also choose to enroll in a Medicare Supplement plan and a Medicare Part D Prescription Drug Plan.
- If you work with fewer than 20 employees, once you are age 65 you will need to enroll in Medicare as it will become your primary health insurance coverage. To avoid potential penalties, it’s important to enroll in Medicare Parts A and B during your “Initial Enrollment Period.” If you are covered by an employer’s plan, you should check with your group health insurance company to determine if they will continue to provide coverage once you enroll in Medicare. They will become your secondary coverage if they will continue to provide coverage. One alternative to remaining in your group plan is to enroll in a Medicare Supplement and Part D Prescription drug plan. Even with IRMAA (Income-Related Monthly Adjustment Amount), most physicians will save money and have lower out-of-pocket costs compared to retaining their group health coverage.
Your Initial Enrollment Period runs for three months before your 65th birthday, your birthday month, and three months after. Missing this deadline could result in permanent late enrollment penalties and potential coverage gaps.
Why Medicare Supplement and Part D Plans Matter
Physicians without dependents on their group plan—especially those paying a portion of employer coverage—often find it more practical and cost-effective to transition to Medicare Supplement and Part D plans.
- Medicare Supplement (Medigap) plans help cover deductibles, copayments, and other out-of-pocket costs.
- Medicare Part D plans provide coverage for prescription drugs, which Original Medicare does not include.
Enrolling in these plans during your Initial Enrollment Period ensures you cannot be denied coverage. However, once this window closes, your guaranteed acceptance ends. At that point, obtaining Medicare Supplement or Part D coverage may require medical underwriting, health screenings, and potential denial of coverage based on your health.
Beyond Medicare: Important Coverage You Still Need
While Medicare provides essential medical coverage, it doesn’t cover everything. Dental, vision, hearing, and life insurance are not included under Original Medicare or Medigap plans. Planning ahead for these expenses now can help protect you from coverage gaps and help you maintain your health, independence, and financial stability.
Medicare Enrollment Support—At No Cost to You
You’ve always been proactive about the health of others—now it’s time to take the same approach for yourself.
Whether you intend to keep practicing or retire, making Medicare decisions before turning 65 is essential to avoid costly, permanent penalties. A licensed TMA Insurance Trust advisor can answer your Medicare questions, assist with enrollment, and help you secure a Medicare Supplement and Part D plan. They’ll also review household discount opportunities—some as high as 12%—to help you and your spouse maximize savings.
Your advisor is your advocate, providing personalized support every step of the way. Call 800-880-8181, Monday through Friday, 8:00 AM to 5:00 PM CST.
For over 70 years, TMA Insurance Trust advisors have been serving Texas physicians, their families and staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.
