Is it Mandatory to Enroll in Medicare?

• by Christian Worstell

Americans may spend years looking forward to the day they become eligible for Medicare insurance.

But is Medicare mandatory? Are there situations in which it might be beneficial for you to not sign up?

In this guide, we take a look at various Medicare coverage options, as well as what you need to know about eligibility, enrollment and whether or not you’re required to sign up.

Is it mandatory to go on Medicare when you turn 65?

Some people are automatically enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) when they first become eligible for Medicare if they’re already receiving certain Social Security benefits. Some people have to sign up.

It is not mandatory to enroll in Medicare when you turn 65 (or at any age, in fact). However, most people receive Medicare Part A without having to pay a premium — and there’s no real way to opt out of it. It can be used alongside with other types of health insurance, though.

If you do not sign up for Medicare Part A or Part B when you first become eligible, you may be subject to a late enrollment penalty if you choose to sign up later on. 

• The Part A late enrollment penalty is only applicable to beneficiaries who do not qualify for premium-free Part A (which we’ll outline below). 
  
  The Part A late enrollment penalty is up to 10 percent of the monthly premium (if you are required to pay one), and you must pay the penalty for twice the number of years that you could have had Part A but did not.
  
  For example, if you were eligible for Part A for two years before you finally signed up, you would have to pay the extra 10 percent penalty for four years.
  
  
• The Part B late enrollment penalty is up to 10 percent of the standard Part B premium for each 12-month period that you could have had Part B but did not. You have to pay this penalty for as long as you are enrolled in Part B.

Late enrollment penalties do not apply to everyone who delays coverage, however.

For example, if you delay enrollment because you have employer-provided health insurance coverage, you may be able to enroll in Medicare Part A and/or Part B at a later date without facing a late enrollment penalty.   

Is paying for Medicare Part A mandatory?

You will qualify for premium-free Medicare Part A benefits if you worked and paid Medicare taxes for at least 10 full years (40 quarters).

Most beneficiaries qualify for premium-free Part A. Enrolling in Medicare Part A does not kick you off your existing health coverage. 

Medicare works with other types of insurance, such as employer coverage, VA insurance and Tricare. If you are still working and have quality health insurance provided by your employer, you can have coordination of benefits to cover your health care costs. 

• If your employer has fewer than 20 employees, Medicare will be the primary payer. That means Medicare will pay first for any covered care you receive, and then your employer insurance will pick up the rest of the services covered by that plan.
  
  
• If your employer has 20 or more employees, your employer insurance will pay first and Medicare will serve as the secondary payer to pick up any additional covered services. 

Some Medicare beneficiaries have to pay a premium for their Part A coverage.

If you did not accumulate at least 40 quarters (10 years) of working and paying Medicare taxes, you will have to pay a premium for your Part A coverage.

• You will pay $240 per month in 2019 for Medicare Part A if you paid Medicare taxes for between 30 and 39 quarters.
  
  
• If you paid Medicare taxes for fewer than 30 quarters, your Part A premium will be $437 per month in 2019.

If you do not qualify for premium-free Part A, you will need to manually enroll in Medicare Part A.

Is Part B of Medicare mandatory?

Medicare Part B is optional, and it covers qualified outpatient care, certain preventive care services and durable medical equipment (DME).

Most beneficiaries pay the standard Part B premium of $135.50 per month in 2019. Some higher income-earners will pay more for their Part B coverage. This higher amount is called the Income-Related Monthly Adjustment Amount, or IRMAA.

Although Part B is optional, more than 9 out of every 10 beneficiaries who were enrolled in Part A in 2017 chose to enroll in Part B as well.¹

It is mandatory to have Medicare Part A and Medicare Part B in order to enroll in a Medicare Advantage (Part C) plan or a Medicare Supplement Insurance (Medigap) plan.

Are other parts of Medicare mandatory?

There are additional types of optional Medicare coverage that are sold by private insurance companies. 

• Medicare Part C (Medicare Advantage) plans provide all the same benefits as Part A and Part B combined into a single plan.
  
  Some Medicare Advantage plans may offer additional benefits that Original Medicare doesn’t cover, such as prescription drug coverage, dental, vision, hearing care, non-emergency transportation, home meal-delivery and more.
  
  Not all benefits and plans are available in all areas.
  
  
• Medicare Part D prescription drug plans provide coverage exclusively for retail prescription drugs, which are not typically covered by Medicare Part A or Part B.

It is not mandatory to enroll in Medicare Advantage plans or Medicare Part D plans. However, Part D plans also have late enrollment penalties if you choose not to sign up but decide you want a plan later.

Call today to speak with a licensed insurance agent who can help you determine your eligibility to enroll and compare Medicare plans in your area.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!