You are not required to take Medicare, but skipping it usually costs you more later

Medicare is not automatic or mandatory the moment you turn 65. You can refuse it entirely, delay it, or take only part of it. However, the government charges a financial penalty if you turn down coverage and sign up later — and that penalty is permanent, added to your monthly bill for life. The exception is if you have health insurance through a current job; in that case, you can delay Medicare without penalty as long as you are still working and covered.

The decision to take Medicare or skip it depends on your age, your current health insurance, and how long you plan to work. Most people benefit from enrolling when they first become may be able to access, but the rules are different depending on your situation.

Key Takeaways

  • You can turn down Medicare at 65, but you will pay a permanent penalty on your monthly premium if you enroll later, unless you had employer health insurance when you became may be able to access.
  • If you are still working and have health insurance through your job, you can delay Medicare without penalty as long as your employer has 20 or more employees.
  • Part A (hospital insurance) has no monthly premium for most people, so there is usually no financial reason to skip it.
  • Part B (doctor visits) and Part D (prescription drugs) carry monthly premiums and late-enrollment penalties if you delay without may have access to coverage.
  • You have a seven-month window around your 65th birthday to enroll without penalty — three months before, the month you turn 65, and three months after.

When you can legally delay Medicare without penalty

You can postpone Medicare enrollment without facing a penalty only if you have health insurance through an employer and you are still actively working. This is called creditable coverage. The employer must have at least 20 employees on the payroll. If you meet these conditions, you can wait to enroll in Medicare Part B and Part D as long as you remain employed and covered.

Once you leave that job or lose the employer coverage, you have eight months to enroll in Part B without penalty. This eight-month window starts the month after your employment ends or your coverage stops, whichever comes first. You must enroll during this window to avoid the permanent surcharge.

Part A (hospital insurance) is different. If you are receiving Social Security benefits, you are automatically enrolled in Part A and Part B at 65, even if you do not want them. If you have not claimed Social Security yet, you can delay Part A enrollment without penalty as long as you have employer coverage, using the same rules as Part B.

The cost of refusing Medicare and enrolling later

If you turn down Medicare Part B or Part D when you first become may be able to access and do not have may have access to employer coverage, you will pay a late-enrollment penalty for as long as you have Medicare. The penalty is a percentage of the standard premium, calculated for each month you were not enrolled after you became may be able to access.

For Part B, the penalty is 10 percent of the standard monthly premium for each full year you delayed. If the standard premium is $164.90 per month in 2024 and you waited three years to enroll, your penalty would be 30 percent — an extra $49.47 per month, permanently added to your bill. The same logic applies to Part D (prescription drug coverage), though the exact amount varies by plan.

Part A has no monthly premium for most people, so there is no late-enrollment penalty for Part A itself. However, if you delay Part A and later need hospital care, you will owe a higher deductible for your first hospital stay.

Why most people enroll even if they do not have to

Part A is free for most people who paid Medicare taxes while working. Because there is no premium and no penalty for delaying it, some people assume they can skip it. However, enrolling in Part A costs nothing and protects you if you need hospital care unexpectedly. The only reason to refuse Part A is if you are certain you will never use hospital services — an impossible may provide to make.

Part B and Part D do carry monthly premiums, so the choice to enroll is more complicated. If you are healthy, have low prescription drug costs, and have other insurance, you might calculate that waiting saves money. However, the permanent penalty usually erases those savings within a few years. A person who delays Part B by five years will pay an extra 50 percent on their premium forever, which typically costs more than the premiums they avoided by waiting.

What happens if you refuse Medicare and use another insurance instead

You can have Medicare and other insurance at the same time. Many people keep employer coverage after 65 and also enroll in Medicare. Medicare becomes the secondary payer, meaning the employer plan pays first and Medicare covers what is left. This is legal and common.

If you refuse Medicare entirely and rely only on employer coverage or private insurance, you are gambling that your other coverage will never end. If you lose that coverage at 70, 75, or 80, you will face the late-enrollment penalty when you finally enroll in Medicare. The penalty applies retroactively to the month you turned 65, even though you did not enroll until years later.

The exception is Medicaid. If you are enrolled in Medicaid, you can delay Medicare Part B without penalty. Once you lose Medicaid coverage, you have 63 days to enroll in Part B without penalty. This is a shorter window than the eight-month window for employer coverage, so you need to act quickly.

How to enroll or decline Medicare

To enroll in Medicare, you contact Social Security. You can explore online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. You can also enroll through Medicare.gov, which will direct you to Social Security.

To formally refuse Medicare, you must sign a form declining Part A, Part B, or both. This form is called the Decline of Coverage form (CMS-20007). You submit it to Social Security or Medicare to create an official record that you turned down coverage. Without this form, Social Security may enroll you automatically when you claim retirement benefits, even if you do not want Medicare.

If you are still working and have employer coverage, you do not need to do anything. You can enroll in Medicare whenever you leave your job or lose coverage. Just make sure to enroll within the eight-month window after your coverage ends.

Questions to ask your doctor or Medicare counselor

Before you decide to refuse or delay Medicare, talk to someone who understands your specific situation. Your doctor can tell you whether your current insurance covers the care you need. A Medicare counselor can walk through the numbers for your circumstances.

Free Medicare counseling is available through the State Health Insurance information Program (SHIP). You can find your state's SHIP office at shiptalk.org or by calling 1-877-839-2675. SHIP counselors are trained to explain your options without pushing you toward any choice.

Frequently Asked Questions

What if I turn 65 while I am still working?

If your employer has 20 or more employees and you have health insurance through that job, you can delay Medicare Part B and Part D without penalty. You must enroll within eight months after you leave the job or lose coverage. Part A has no penalty for delay, but you should still enroll to protect yourself against unexpected hospital costs.

Can I enroll in only Part A and skip Part B?

Yes. Part A is hospital insurance and Part B is doctor and outpatient care. You can take Part A alone, though most people enroll in both. If you skip Part B now, you will pay a penalty when you enroll later — unless you had may have access to employer coverage when you turned 65.

What if I miss the seven-month enrollment window around my 65th birthday?

You can still enroll, but you will likely face a late-enrollment penalty on Part B and Part D. The penalty is permanent and based on how many months you were not enrolled after you became may be able to access. The exception is if you had creditable coverage (employer insurance or Medicaid) during that time — then you have eight months after that coverage ends to enroll without penalty.

Does refusing Medicare affect my Social Security benefits?

No. You can claim Social Security retirement benefits and refuse Medicare at the same time. However, if you claim Social Security at 65, you will be automatically enrolled in Part A and Part B unless you formally decline them in writing before enrollment happens.

What if I enroll in Medicare and then change my mind?

You can drop Part B or Part D during the annual enrollment period (October 15 to December 7 each year) or if you have a may have access to life event, such as losing employer coverage. Part A is harder to drop once you are enrolled. Talk to Medicare before you make changes, because dropping coverage and re-enrolling later will trigger the late-enrollment penalty.