Medicare Part B is not mandatory for everyone, but skipping it usually costs you more later

Medicare Part B covers doctor visits, outpatient care, lab tests, and medical equipment. You are not forced to take it when you turn 65, but if you delay without a valid reason, you will pay a permanent penalty on your premiums for as long as you have Medicare. The penalty is 10 percent for each full year you could have had Part B but did not sign up.

Most people should take Part B when they first become may be able to access at 65. The main exception is if you are still working and covered by your employer's health plan — in that case, you can delay Part B without penalty, as long as you sign up within eight months of leaving that job or losing the coverage.

Key Takeaways

  • You can refuse Medicare Part B at 65, but you will pay a 10 percent monthly penalty for each year you delayed, added to your premiums for life.
  • If you are covered by an active employer health plan when you turn 65, you can delay Part B without penalty as long as you enroll within eight months of losing that coverage.
  • Part B covers doctor visits, lab work, imaging, and outpatient procedures — things Original Medicare Part A does not pay for.
  • Your initial enrollment window is the three months before, the month of, and three months after your 65th birthday; missing this window triggers the penalty unless you have employer coverage.

Who can skip Part B without a penalty

You can delay Part B without penalty if you have creditable coverage through an employer or union when you turn 65. Creditable coverage means a health plan that is at least as good as Medicare Part B. Most employer plans may have access to.

The key rule: you must enroll in Part B within eight months of the date your employer coverage ends or you stop working, whichever comes first. If your employer plan ends on March 15, you have until November 15 to sign up for Part B without penalty. If you miss that window, the 10 percent penalty applies.

If you are still working at 65 and your employer has 20 or more employees, you can also delay Part A (hospital insurance) without penalty. Employers of that size are required to offer coverage that is primary to Medicare, so Medicare does not pay first.

What happens if you skip Part B and have no employer coverage

If you turn 65, do not sign up for Part B, and do not have employer coverage, you will owe a penalty. The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. That percentage is added to your premium permanently.

For example, if you turn 65 in 2024 and do not sign up until age 68, you delayed for three years. Your penalty would be 30 percent of the current Part B premium, added to whatever you pay each month for the rest of your life. The standard Part B premium changes each year, so your penalty amount will change too.

The only exception to this penalty is if you have limited income and resources and meet Medicaid rules in your state. Some states waive the penalty in these cases, but you have to ask — it is not automatic.

Your enrollment window and what to do if you miss it

Your Initial Enrollment Period (IEP) runs for seven months: the three months before your 65th birthday, the month you turn 65, and the three months after. If you sign up during this window, your coverage starts the first day of the month you turn 65 (or the first day of the following month if you sign up in your birth month).

If you miss your IEP and have no employer coverage, you can still sign up during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage starts July 1 of that year. But you will owe the penalty.

If you have employer coverage, do not wait for the General Enrollment Period. Sign up within eight months of losing that coverage, or you will trigger the penalty even though you had a valid reason to delay.

Part B costs and what it covers

Part B has a monthly premium (the standard amount in 2024 is $164.90, but it varies by income). You also pay a yearly deductible (currently $240) and then 20 percent coinsurance for most services after that. Some preventive care is covered at no cost.

Part B covers doctor office visits, emergency room care, outpatient surgery, lab tests, imaging like X-rays and MRIs, physical therapy, and durable medical equipment such as wheelchairs and oxygen. It does not cover routine dental, vision, or hearing care. Part A covers hospital stays and skilled nursing facility care, so most people need both.

If you choose Original Medicare (Part A and B), you can also buy a Medigap policy to cover the costs Medicare does not pay. Alternatively, you can choose a Medicare Advantage plan (Part C), which is an all-in-one alternative to Original Medicare that includes Part B. Either way, you are getting Part B coverage — you are just choosing how to structure it.

What to ask your doctor or Social Security

Before you decide to skip Part B, ask your employer's benefits office whether your health plan is creditable coverage under Medicare rules. Do not assume — some plans are not. If it is creditable, ask for written proof, because you will need it if you ever have to prove you had valid coverage.

Call Social Security at 1-800-772-1213 to confirm your enrollment window and to ask about your specific situation. They can tell you whether your employer coverage qualifies and what date your eight-month window closes. You can also visit your local Social Security office in person.

If you are on Medicaid or have very low income, ask whether your state waives the Part B penalty. Contact your state Medicaid office or your State Health Insurance information Program (SHIP) — the number is on Medicare.gov under "Get Local Help".

When to seek help from Medicare

Contact Medicare when ready if you realize you missed your enrollment window and did not have employer coverage. You can request a Special Enrollment Period if you have a may have access to life event — such as losing employer coverage, moving out of your service area, or being wrongly told you did not need to enroll. Medicare will review your request, and if approved, you can enroll without penalty.

If you are already paying a penalty and believe you had valid employer coverage that Medicare did not recognize, you can file an appeal. Contact your local Social Security office with proof of your coverage dates.

Frequently Asked Questions

Can I take Part A without Part B?

Yes. Part A covers hospital and skilled nursing care; Part B covers doctor visits and outpatient services. You can have Part A alone, though most people need both. If you have employer coverage at 65, you can delay both Part A and Part B if your employer has 20 or more employees.

What if I turn 65 while still working?

You can delay both Part A and Part B without penalty if your employer has 20 or more employees and you are covered by their health plan. You must enroll within eight months of leaving the job or losing coverage. If your employer has fewer than 20 employees, you must take Part A at 65, though you can delay Part B if you have coverage.

Does the penalty ever go away?

No. The 10 percent penalty is permanent and stays on your premium for life. It does not disappear after a certain number of years. The only way to avoid it is to enroll during your Initial Enrollment Period or within eight months of losing employer coverage.

What if I cannot afford Part B?

If your income is low, you may be able to get help paying your Part B premium through Medicaid or the Medicare Savings Programs. Contact your state Medicaid office or your State Health Insurance information Program to learn what programs may be available in your state.

Do I need Part B if I have a Medicare Advantage plan?

No, but you do need Part A. Medicare Advantage (Part C) is an alternative way to get Part B coverage — it includes doctor and outpatient care as part of the plan. You cannot have both Original Medicare Part B and a Medicare Advantage plan at the same time.