 [ Symptoms ] why do you have to sign up for medicare if you already have good insurance and are still working  is it the insurance company or medicare enforcing this if you do not are you penalized and if you are not drawing social security do you still have to pay for it when you sign up [ Disease ] you do not need to sign up for medicare if you have employer based health insurance but your employer coverage must be from a company with more than 20 employees the key is that the insurance be considered creditable or generally about as good as medicare coverage ask your employer for confirmation that your plan qualifies when you do sign up for medicare    whether you draw on social security or not    you will receive medicare part a at no cost and you will pay a monthly premium for part b if you need drug coverage there will also be a monthly cost for part d once you lose your work based coverage you need to sign up for medicare fairly quickly to avoid penalties