You can turn down Medicare Part A and Part B, but the process and timing matter

You have the right to refuse Medicare Part A (hospital insurance) and Part B (medical insurance) when you first become may be able to access, usually at 65. You can also drop coverage later if you have other insurance that meets certain standards. The catch: if you turn it down and change your mind, you may face permanent premium penalties unless you have a valid reason for the delay.

The most common reason to decline is that you are still working and covered by your employer's health plan. If that plan has 20 or more employees, you can safely turn down Medicare without penalty. Once you leave that job or lose the coverage, you have eight months to sign up for Medicare without extra cost. If you miss that window and did not have may have access to coverage, you will pay a higher premium for Part B for as long as you have Medicare.

Key Takeaways

  • You must actively decline Medicare Part A and Part B in writing — they do not automatically enroll you, but you must formally refuse to avoid coverage you do not want.
  • If you have employer coverage with 20 or more employees, you can turn down Medicare without penalty and have eight months after leaving that job to sign up.
  • Declining Medicare Part A (hospital insurance) can result in a permanent 10 percent premium increase if you enroll later without a may have access to reason.
  • You can drop Medicare Part B or Part D (prescription drug) during the annual open enrollment period in October and November, or when ready if you gain other may have access to coverage.
  • Contact Social Security or Medicare directly to decline or drop coverage — do not rely on a letter or verbal statement alone.

How to formally decline Medicare when you first turn 65

Social Security will send you a notice about Medicare may be able to access three months before your 65th birthday. If you want to refuse it, you must respond in writing. straightforward not signing up is not enough — you need to submit a formal declination to Social Security or Medicare.

Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for a form to decline Part A and Part B. You can also visit your local Social Security office in person. Keep a copy of your signed declination for your records. This protects you if Medicare later claims you enrolled automatically.

If you have employer coverage, mention that on the form. Social Security will note it in your file. When you lose that coverage, you will have a clear eight-month window to enroll without penalty — Social Security will know to count the months from the date your employer plan ended, not from when you first turned 65.

What happens if you decline and then change your mind

If you declined Part A and later want to enroll, you can do so during the general enrollment period (January 1 to March 31 each year). However, coverage does not start until July 1 of that year. More importantly, you will owe a permanent 10 percent increase on your Part A premium for twice the number of years you were may be able to access but not enrolled — this penalty stays with you for life.

Part B has the same penalty structure. If you declined Part B and enroll later outside of a may have access to circumstance, your premium goes up 10 percent for each full year you were may be able to access but not enrolled. This penalty also lasts as long as you have Medicare.

The only way to avoid these penalties is to have had may have access to coverage (like an active employer plan) during the time you were not enrolled in Medicare. That is why documenting your employer coverage when you decline is so important.

Dropping Medicare Part B or Part D after you have enrolled

If you enrolled in Medicare but want to drop Part B (doctor and outpatient care) or Part D (prescription drugs), you can do so during the annual open enrollment period from October 15 to December 7. Your coverage ends on December 31 of that year. You can also drop coverage when ready if you gain other insurance that covers the same services — for example, if you get a new job with health benefits or become covered under a spouse's plan.

To drop Part B or Part D, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. You will need to provide the date your new coverage begins. Medicare will ask you to confirm in writing, so request written confirmation of your request and keep it.

Dropping Part B or Part D does not affect Part A (hospital insurance). If you want to drop Part A, the rules are stricter and require a longer process — contact Medicare directly to understand your options.

When you can drop Medicare without a penalty

You can drop Part B or Part D without penalty if you have other coverage that meets Medicare's standards. This includes employer health plans, TRICARE (military coverage), the Federal Employees Health Benefits Program (FEHB), or certain state Medicaid plans. You must enroll in your new coverage before your Medicare coverage ends, and you must notify Medicare within 63 days of losing that coverage if you want to re-enroll later without penalty.

If you drop Part B and later want it back, you have the same eight-month window as someone who declined at 65 — but only if you had may have access to coverage during the time you were not enrolled. Without that documentation, you face the permanent premium penalty.

Declining Part D (prescription drug coverage)

Part D is optional, unlike Part A and Part B. You can decline it when you turn 65 or at any time during the annual open enrollment period. However, if you decline Part D and do not have other creditable prescription drug coverage (such as from an employer or union), you will pay a permanent penalty when you eventually enroll. The penalty is 1 percent of the national average Part D premium for each month you were not enrolled — this also stays with you for life.

If you have coverage from an employer, retiree plan, or the VA that covers prescription drugs at least as well as Medicare does, you can decline Part D without penalty. Ask your plan administrator for a letter stating that your coverage is "creditable" — keep this letter in case you need to prove it later.

What to do if you made a mistake or missed a important date

If you declined Medicare by mistake or missed the important date to enroll without penalty, contact Medicare or Social Security when ready. Explain your situation. In some cases, Medicare may grant a Special Enrollment Period (SEP) if you have a may have access to life event — such as losing employer coverage, moving out of a service area, or experiencing a significant change in your health status.

A SEP is not may provide, and the rules are strict. Medicare will review your case and decide whether your reason qualifies. Even if you receive a SEP, you may still owe back premiums for the months you were not enrolled. Document everything: keep records of when you lost coverage, copies of any letters from your employer, and notes on any conversations with Medicare or Social Security.

Frequently Asked Questions

Can I decline Medicare Part A but keep Part B?

No. Part A and Part B are linked. If you decline one, you must decline both. However, you can later enroll in just Part B if you change your mind, though you may face penalties on both parts depending on how long you waited.

What if my employer says I do not need to decline Medicare?

Decline it anyway in writing. Your employer's statement is not enough protection. If a dispute arises later about whether you were supposed to be covered, your signed declination is the only proof that matters to Social Security and Medicare.

Do I lose Medicare if I do not use it for a certain amount of time?

No. Once you are enrolled in Medicare, you keep it even if you do not use it. The only way to stop coverage is to formally drop it or move out of the United States permanently.

Can I decline Medicare and use only Medicaid?

If you are may be able to access for both Medicare and Medicaid, you cannot decline Medicare. You must be enrolled in both — this is called being "dual may be able to access." Medicaid will pay some of your Medicare costs, but you cannot use Medicaid alone.

What if I live outside the United States?

You can keep Medicare Part A (hospital insurance) if you live abroad, but Part B coverage is limited outside the U.S. If you move permanently outside the country, contact Medicare to discuss your options. You may be able to drop Part B without penalty if you have other coverage.