You can decline Medicare Part A and Part B when you first become may be able to access, but the choice depends on your age and whether you have employer coverage

If you are approaching 65 and do not want Medicare, you can turn it down. The process differs based on your situation: if you are still working and covered by your employer's health plan, you can decline Part A and Part B without penalty. If you are retired or not covered by an employer plan, declining Medicare usually means paying a higher premium later if you change your mind.

The key rule is creditable coverage. If your employer plan is as good as or better than Medicare (which most large employer plans are), you can refuse Medicare without financial consequence. If you have no coverage or coverage that is not creditable, declining Medicare can cost you permanently.

Key Takeaways

  • You can decline Medicare Part A and Part B at 65 if you have creditable coverage through an employer or spouse's employer.
  • If you decline without creditable coverage, you will pay a 10 percent premium increase for Part B for every year you delayed, for life.
  • You must actively decline Medicare in writing; straightforward not signing up does not count as a choice.
  • If you decline and later want to enroll, you have limited windows to do so without penalty — usually only during your employer coverage loss or the General Enrollment Period.
  • Part D (prescription drug) has its own penalty rules: if you go without creditable drug coverage, you pay more when you enroll later.

Declining Medicare when you have employer coverage

If you are still working or your spouse is still working, and your employer offers health insurance, you can turn down Medicare Part A and Part B. Your employer plan becomes your primary insurance instead. This is the cleanest scenario because you avoid penalties later.

You must tell Social Security in writing that you do not want Medicare. You can do this by calling Social Security at 1-800-772-1213, visiting your local Social Security office, or submitting a written statement. straightforward not enrolling is not the same as declining — Social Security may enroll you automatically if you do not act.

Keep records of your employer coverage and the dates it was in effect. You will need this proof later if you want to enroll in Medicare without penalty after your employment ends.

What happens if you decline without creditable coverage

If you turn down Medicare at 65 and you do not have creditable employer coverage, you will face a permanent premium penalty. For Part B, this penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled. If you delayed for three years, you pay 30 percent more than the base premium for the rest of your life.

Part A (hospital insurance) has a similar penalty: 10 percent per year, but only if you delay more than 12 months after you first become may be able to access. Part A penalties are less common because most people do not have to pay for Part A if they or their spouse paid Medicare taxes for 10 years or more.

These penalties are permanent. Even if you enroll later and your circumstances change, you cannot get the penalty waived or removed. This is why the decision to decline matters most if you have no other coverage.

How to formally decline Medicare

Declining Medicare requires a written statement. You can do this in three ways:

  1. Call Social Security: 1-800-772-1213. Ask to speak with a representative and tell them you want to decline Medicare Part A and Part B. They will document your choice in your file.
  2. Visit a Social Security office: Bring a photo ID and ask to sign a form declining Medicare. You will receive a copy for your records.
  3. Mail a written statement: Send a letter to your local Social Security office stating your name, date of birth, and that you decline Medicare Part A and Part B, effective when ready. Include your signature and the date.

Do this before your 65th birthday or as soon as you realize you do not want Medicare. The earlier you act, the clearer your record will be.

Re-enrolling after you decline

If you decline Medicare and later want to enroll, you have limited windows. The main ones are:

  • When your employer coverage ends: You have eight months from the date your coverage ends to enroll in Medicare without penalty. This is called the Special Enrollment Period. You must provide proof that your employer coverage ended.
  • The General Enrollment Period: January 1 to March 31 each year. However, if you enroll during this period and you do not have creditable coverage, you will owe the penalty for the years you delayed.
  • If you become disabled or end up on dialysis: You may have other enrollment windows. Contact Social Security to ask.

Missing these windows means you cannot enroll until the next General Enrollment Period, and you will still owe the penalty.

Prescription drug coverage and Part D penalties

Part D (prescription drug coverage) has its own rules. If you decline Part D and do not have creditable drug coverage from your employer, you will pay a penalty when you enroll later. The penalty is about 1 percent of the national average Part D premium for each month you were without coverage, added to your premium permanently.

If your employer plan covers drugs at least as well as Medicare Part D, that counts as creditable coverage and you avoid the penalty. Ask your employer's benefits office whether your plan is creditable. If it is, get a letter stating this — you will need it if you enroll in Part D later.

Stopping Medicare after you have already enrolled

If you enrolled in Medicare but now want to stop, the rules are stricter. You cannot straightforward cancel Medicare Part A and Part B once you are enrolled. You can only disenroll in specific situations:

  • You return to work and gain creditable employer coverage.
  • You move outside the United States and will not return.
  • You are enrolled in both Medicare and Medicaid, and your state Medicaid program asks you to disenroll.

If you meet one of these conditions, contact Medicare at 1-800-MEDICARE (1-800-633-4227) to request disenrollment. You will need to provide proof of your new coverage or change in circumstance.

Frequently Asked Questions

What counts as creditable coverage?

Creditable coverage is health insurance that is at least as good as Medicare. Most employer plans offered by large companies may have access to. Ask your employer's benefits office or your spouse's employer to confirm. Get written proof if you decline Medicare — you will need it later.

If I decline Medicare at 65 and keep working until 70, can I enroll without penalty?

Yes, if you have creditable employer coverage the whole time. When your employment ends, you have eight months to enroll in Medicare without owing any penalty. Keep records of your coverage dates.

What if I decline Part B but want Part A?

You can decline Part B alone if you have creditable coverage elsewhere. However, Part A and Part B are usually enrolled together. Contact Social Security to discuss your specific situation, as rules vary based on your work history and coverage type.

Do I have to decline before my 65th birthday?

No, but it is clearer if you do. You can decline after 65, but Social Security may have already enrolled you automatically. If that happens, you have a limited window to disenroll. Act as soon as you know you do not want Medicare.

What if my employer coverage ends unexpectedly?

You have eight months from the date your coverage ends to enroll in Medicare without penalty. Contact Medicare or Social Security right away and bring proof that your coverage ended — a termination letter from your employer or benefits office works.