More than 61.2 million people in the United States are Medicare beneficiaries, making it one of the most extensive healthcare programs on the planet.
The majority of these individuals received retirement benefits and were automatically enrolled in the program once they turned 65. Other seniors may have manually enrolled around their 65th birthday.
If you’re approaching the age of eligibility, you may wonder whether Medicare is mandatory at age 65 and what the consequences of opting out or delaying enrollment may be.
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While registering for the Medicare program is often automatic, you don’t have to sign up if you aren’t automatically enrolled. If you decide to delay Medicare enrollment because you or your spouse have health insurance coverage through an employer or another source, you may be able to enroll in Medicare Part A and/or Part B at a later date without facing late enrollment penalties.
As with all your health care decisions, you can choose whether to be part of the Medicare program or not. However, there are consequences for declining or delaying enrollment.
Two common reasons people may decide they don’t want to become Medicare beneficiaries include:
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.
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.
Technically, no Medicare Part A is not mandatory.
If you don’t sign up for Medicare Part A, however, you must withdraw from all federal benefits programs. That means you cannot receive Social Security or Railroad Retirement Board benefits. You must also repay any benefits you have already received if you decline Medicare. This is one reason why most people keep their Part A coverage once their eligible.
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.
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.
If you do not qualify for premium-free Part A, you will need to manually enroll in Medicare Part A.
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 $174.70 per month in 2024. 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, 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.
Medicare isn’t a mandatory program, so you’re free to opt-out of the program if you prefer. However, Medicare is one of the benefits that people work and pay taxes for. After you retire, taking advantage of this program makes sense.
Remember that most people qualify for premium-free Part A. If you’ve worked and paid taxes for at least 10 full years or 40 quarters, you won't pay monthly premiums. That means that if you qualify, being in Medicare doesn’t need to cost you money unless you're using the program.
Consider the consequences carefully before deciding you don’t want to become a Medicare beneficiary.
It is not mandatory to enroll in Medicare Advantage plans or Medicare Part D prescription drug 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.
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Zia Sherrell is a digital health journalist with over a decade of healthcare experience, a bachelor’s degree in science from the University of Leeds and a master’s degree in public health from the University of Manchester. Her work has appeared in Netdoctor, Medical News Today, Healthline, Business Insider, Cosmopolitan, Yahoo, Harper's Bazaar, Men's Health and more.
When she’s not typing madly, Zia enjoys traveling and chasing after her dogs.