If your Raleigh employer has 20 or more employees, your group health plan is primary — you can safely delay Medicare Part B with no penalty. If your employer has fewer than 20 employees, Medicare becomes primary at 65, and you must enroll during your 7-month Initial Enrollment Period or face a permanent 10% Part B surcharge for every 12 months you delayed. In 2026, Part B costs $202.90/month — a 3-year delay would add $60.87/month to that premium for life. For your specific situation in Wake County, call Rob Simm at (828) 761-3326 — free, no obligation.

What Wake County families ask

What happens if I get Medicare enrollment wrong while still working?

These are the four questions I hear most from Raleigh-area workers approaching 65.

What if my employer has exactly 20 employees?

At 20 or more, your employer plan is primary and you can delay Part B safely. At 19 or fewer, Medicare is primary at 65 — no exceptions. HR sometimes counts wrong. I verify the number directly.

Can I just sign up for Part A and skip Part B?

Yes — Part A is premium-free for most people and doesn’t trigger a penalty. But Part B has the late enrollment penalty. Many workers enroll in Part A at 65 and delay Part B if employer coverage qualifies.

What if I retire mid-year — when does my SEP start?

Your 8-month Special Enrollment Period starts the month after your employment ends or your group coverage ends, whichever comes first. Miss that 8-month window and the penalty kicks in.

Does COBRA count as creditable coverage?

No. COBRA does not count as employer coverage based on current employment. If you retire and elect COBRA instead of enrolling in Medicare, you will owe the Part B late enrollment penalty. This is the most common mistake I see.

⚠️ The Part B Penalty Is Permanent

The 10% surcharge for each 12-month period you delayed is added to your Part B premium for life. There is no cap, no forgiveness, and no appeals process. A 3-year delay = 30% higher Part B premium forever. In 2026, that’s an extra $60.87/month on top of $202.90 — for life. One phone call to verify your employer size prevents this entirely.

The difference

What does a broker check that Medicare.gov doesn’t?

What do you need to know?	Medicare.gov	Rob Simm — NC #10447418
Employer size verification	Tells you the 20-employee rule exists	I call your HR and verify the exact count before you make a decision
Penalty calculation	Shows the formula — 10% per 12 months	I run the math with your specific delay period and show you the lifetime cost
SEP timeline	Says you get 8 months after employment ends	I map your exact start date, end date, and enrollment deadline on a calendar
COBRA trap	Buries the COBRA exclusion in fine print	I flag it immediately — COBRA does not protect you from the penalty
CMS-L564 form	Doesn’t mention it unless you search	I tell you to get it from HR before your last day — it’s your proof of coverage
Ongoing support	Different agent every call, hold times	Same broker, same phone number, same answer next year

2026 Medicare numbers

What are the key Medicare costs for Wake County residents in 2026?

$202.90

Part B premium per month

2026 standard rate. Higher with IRMAA surcharge based on income above $106,000.

$283

Part B annual deductible

You pay this before Medicare covers 80% of outpatient care.

$9,350

MA in-network out-of-pocket max

2026 cap on in-network Medicare Advantage spending.

$2,100

Part D out-of-pocket cap

No catastrophic Rx costs in 2026. Insulin capped at $35/month.

💡 Broker Tip — Wake County

If you work for a Raleigh-area employer with between 15 and 25 employees, do not rely on HR’s word alone — the 20-employee threshold is based on the number of employees the company had for 20 or more calendar weeks in the current or preceding year. Seasonal fluctuations can push a company above or below the threshold year to year. I verify this directly so you don’t find out the hard way at enrollment.

— Rob Simm, Licensed Medicare Broker, NC #10447418

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Real scenario · Wake County

What does a Part B penalty actually cost over a lifetime?

Didn’t verify employer size

+$60.87/mo

Worked 3 years past 65 at a company with 18 employees. Assumed employer plan was primary. Now pays a permanent 30% Part B surcharge — $60.87/month extra on top of $202.90, for life. Over 20 years, that’s $14,609 in avoidable penalties.

Called Rob first

$0 penalty

Called before turning 65. Rob verified employer had only 18 employees — Medicare was primary. Enrolled during IEP. Zero penalty. Same doctor, same coverage, $0 extra per month. Total cost of the phone call: 10 minutes.

It pays to talk to the right broker

How much does it cost to talk to a Medicare broker?

It doesn’t — because I get paid by the insurance carrier to manage your plan. Most call centers get paid more to steer your business toward certain carriers based on volume and contracts. The only thing I’m optimizing for is making sure you’re covered correctly when you actually need it. That’s what keeps people coming back. And referring their neighbors.

Common questions

Frequently asked questions

Can I delay Medicare if I’m still working past 65 in Wake County?

Yes — but only if your employer has 20 or more employees and you’re covered by the employer’s group health plan. If your employer has fewer than 20 employees, Medicare becomes primary at 65 and you must enroll during your Initial Enrollment Period to avoid a permanent Part B penalty. Call Rob Simm at (828) 761-3326 to verify your specific situation.

What is the Part B late enrollment penalty in 2026?

The Part B penalty is 10% of the standard premium ($202.90/month in 2026) for each full 12-month period you could have had Part B but didn’t. A 2-year delay adds $40.58/month to your premium — permanently. The penalty never goes away.

How do I prove I had creditable employer coverage?

Request a CMS-L564 form (Request for Employment Information) from your employer’s HR department. This form proves you had group health plan coverage based on current employment. Without it, Medicare may not waive the late enrollment penalty. Get this form before your last day of work.

What is the Medicare Special Enrollment Period for people who work past 65?

When you or your spouse stop working or lose employer group health coverage, you get an 8-month Special Enrollment Period to sign up for Part B without penalty. This window starts the month after employment ends or the coverage ends, whichever comes first. Do not wait — the 8-month clock starts automatically whether you act or not.

Are there Medicare brokers in Wake County, NC?

Yes — Rob Simm at GenerationHealth.me serves Wake County and all 100 NC counties. Licensed NC #10447418, AHIP Certified. Call (828) 761-3326 for a free 10-minute consultation — no cost, no obligation.

Related Medicare guides

Medicare Enrollment in NC – 2026 Guide Working Past 65 – Medicare Enrollment Special Enrollment Periods in NC Extra Help/LIS Eligibility NC 2026 Compare Medicare Advantage Plans in NC Extra Help / LIS in NC – 2026 Eligibility Guide Free Medicare Quotes Online Cheap Health Insurance Without Employer Coverage

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Robert Simm

Licensed Independent Medicare Broker

Helping NC families navigate Medicare since 2014. Independent — I work with all carriers and get paid the same regardless of which plan you choose. I verify provider networks with Duke Health directly and answer my own phone the next year when something changes.

📞 (828) 761-3326 📋 NC #10447418 🏥 AHIP Certified ⭐ 5.0 · 20+ reviews 📍 2731 Meridian Pkwy, Durham NC 27713 🕐 Mon–Fri 9am–7pm ET

Last Updated: 2026-05-04 | Reviewed By: Robert Simm, Licensed Medicare Broker, NC #10447418 | Next Review: October 2026

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE (1-800-633-4227) for information on all of your options. GenerationHealth.me and Robert Simm are independent agents not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent may contact you. Information on this page is for educational purposes only and should not be considered legal or financial advice. Plan availability, premiums, and benefits vary by location and carrier. © 2026 GenerationHealth.me