Most people who are eligible for Medicare choose to use its medical care coverage and benefits once they turn 65. But for some, choosing different coverage or even forgoing coverage altogether are options to explore. The question is, when you turn 65, do you have to sign up for Medicare?
Deferring Medicare coverage is uncommon, but it is possible. Let’s look at what is and isn’t required for Medicare, why some may defer coverage and how to do it.
Is Medicare mandatory at age 65?
No, Medicare is not mandatory. However, many people have spent the better part of their careers paying into the program, and there are good reasons to accept it. Medicare helps cover essential health services, and affordable access to medical care becomes even more important as you age.
Opting out of Medicare can be tricky, especially if you receive Social Security or Railroad Retirement Board benefits before turning 65. If you’re already receiving these benefits, you will be automatically enrolled in Original Medicare when you become eligible.
Can you opt out of Medicare?
Yes, you can choose to opt out of Medicare. However, there’s a difference between delaying enrollment and declining Medicare coverage altogether.
There are several reasons to delay enrolling in Medicare. One involves monthly premium costs. If you’re still working past 65, it may be cheaper to keep your employer-sponsored health plan. In this situation, if your health insurance is provided through a large-group insurer that covers everything Original Medicare does, you may be able to defer Medicare enrollment.
It may also make sense to delay Medicare enrollment to keep contributing to a health savings account (HSA) or because you already have coverage through Veterans Affairs, TRICARE or CHAMPVA. If you’d like to delay enrolling for any of these reasons, you won’t be charged penalties for enrolling in Medicare later.
Declining Medicare coverage is something else entirely, and it can be complicated. If you choose to decline Medicare, you’ll lose all your Social Security or Railroad Retirement Board benefits and will be required to return all payments you’ve received.
How to opt out of Medicare
To opt out of Original Medicare coverage, you need to provide written, signed consent. To start this process, contact the Social Security Administration, which processes Medicare applications. If you were automatically enrolled in Original Medicare, your welcome packet will have deferment instructions for you. This includes sending your Medicare ID card back. If you keep your card, you’ll have to begin paying Part B premiums.
The parts of Medicare
Medicare is comprised of different parts which cover specific types of health care services. Original Medicare, which is what you become eligible for when you turn 65, includes Part A and Part B. Other parts are optional. Here’s what you need to know.
- Medicare Part A (Hospital coverage): You become eligible for Part A coverage after you (or your spouse or partner) have paid into Medicare for 10 years – specifically, 40 quarters – throughout your career. Part A is premium-free when you turn 65, so it’s a bit easier to defer Part A coverage. Most sign up for Part A coverage during their Initial Enrollment Period (IEP).
- Medicare Part B (Medical coverage): Part B includes monthly premium payments, which were $174.70 in 2024. This rate can change based on your income. While you can defer Part B coverage, doing so may result in robust penalties. If you eventually do decide to enroll in coverage, these penalties can last throughout the rest of your time as a Medicare beneficiary.
- Medicare Part D (Prescription drug coverage): Part D coverage is not covered by Original Medicare – it’s optional through a Part D prescription drug plan or a Medicare Advantage plan. Medicare Advantage plans (Part C) are required to provide Part A and B coverage, and if a plan also includes Part D, you have all your coverage options in one place.