Yes, you can stay on private insurance after age 65, primarily if you or your spouse are still actively working and covered by a group plan from an employer with 20 or more employees. This allows you to delay Medicare Part B without penalties. However, you must enroll in Medicare within 8 months of losing that coverage.
You do not have to enroll in Medicare right away, and you can keep your current group health insurance. An individual will not receive a late penalty if they have coverage under a group health plan with 20 or more employees.
If you reach age 65 and already have comprehensive health insurance, you don't have to enroll in Medicare right away, but in some cases, enrollment at age 65 is essential to avoid gaps in coverage.
Despite all the above, you can keep your ACA plan after age 65 in addition to Medicare, but if you qualify for free Part A, you no longer qualify for the ACA subsidy (if you got it, you'd need to pay it back when you next file your tax return).
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
There are, however, exceptions allowing you to buy private health insurance instead of Medicare. These include: If you are eligible for Medicare due to having end-stage renal disease (ESRD) and haven't signed up for Medicare. If you haven't signed up for Medicare because you would have to pay a Part A premium.
Here are some of the biggest Medicare mistakes to avoid:
Generally speaking, if you do not sign up for Medicare on time, you may have to pay a 10% surcharge on Medicare Part B premiums for each year you go without coverage starting the month you're eligible for coverage. You'll have to pay this penalty each time you pay your premiums as long as you have Part B.
Yes, you can have both Social Security and Medicare at the same time, and they often work together, with your Social Security record qualifying you for Medicare, especially if you're 65+ or have received Social Security disability for 24 months. Most people sign up for both through the Social Security Administration (SSA).
With regard to Medicare, the decision is yours. Your FEHB coverage will continue whether or not you enroll in Medicare. If you can get premium-free Part A coverage, we advise you to enroll in it. Most Federal employees and annuitants are entitled to Medicare Part A at age 65 without cost.
If you (or your spouse) have health insurance from a job:
If you or your spouse are still working, you may be able to wait to sign up for Medicare without paying a late enrollment penalty. Where you have group health insurance that's available to everyone at the company.
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
In 2025, there are still many healthcare costs that Medicare won't cover — from dental work and vision needs to hearing aids, overseas medical care, and, perhaps most significantly, long-term custodial care. But the good news is that you don't have to face these gaps unprepared.
Disadvantages of private health insurance
Many individual policies can cost several hundred dollars a month, and family coverage can be even higher. And even the more comprehensive policies come with deductibles and copays that insureds must meet before their coverage kicks in.
It's possible to have Medicare and private insurance at the same time, especially if you're still working or covered by a spouse's employer plan. When you have both, one becomes the primary payer and the other pays second. For example, if your employer has fewer than 20 employees, Medicare may pay first.
If you can't afford healthcare in America, you risk significant medical debt and worse health outcomes, but you can get emergency stabilization regardless of ability to pay, and can seek help through Medicaid, CHIP, Marketplace subsidies, community health centers, or catastrophic plans, with options varying by state and income. Delaying care due to costs often leads to poorer health, while options like public clinics offer sliding-scale fees, and government programs provide free or low-cost coverage for eligible individuals.
Obamacare (ACA) plan costs vary wildly, but in 2025/2026, average monthly premiums before subsidies ranged from around $400-$600+, yet most people with subsidies pay much less, often $0 to $50/month, due to significant tax credits, with many finding plans affordable by visiting HealthCare.gov or state marketplaces. Your actual cost depends heavily on income, location, age, family size, and plan choice (Bronze, Silver, Gold).