Frequently Asked Questions About Medicare Age Eligibility

Can I keep my Health Savings Account (HSA) after I turn 65?

Yes, you can keep your existing HSA account and spend accumulated funds completely tax-free on qualified medical expenses, medical copays, and Medicare Part B premiums. However, once you enroll in any portion of Medicare (Part A or Part B), you can no longer make new contributions to the HSA without incurring an IRS 6% excise tax penalty.

What happens if I turn 65 but my spouse is younger and covered under my plan?

Medicare does not offer family or spousal coverage; every individual policy belongs solely to one person. If you drop your active employer plan to switch to Medicare at 65, your younger spouse loses their group health coverage. In this situation, your spouse must obtain interim coverage through COBRA continuation, an individual ACA Marketplace policy, or their own employer plan until reaching age 65.

Do I have to sign up for Medicare if I am 65 and still working?

If your employer has 20 or more active employees and you maintain primary group health coverage through your job, you can safely delay Medicare Part B without incurring penalties. You will receive an eight-month Special Enrollment Period (SEP) to sign up for Part B when your active employment or health coverage ends, whichever occurs first.

Is Medicare Part A completely free when I turn 65?

Part A is premium-free only if you or your spouse paid Medicare payroll taxes for at least 40 calendar quarters (10 years) of qualifying employment. If you do not meet this threshold, you must pay a monthly Part A premium of either $311 or $565 in 2026, depending on your total accumulated work history.