Do You Have to Take Medicare, or Can You Turn It Down?

Medicare is not automatic — you can delay or refuse it, but the choice comes with real costs

You do not have to take Medicare when you turn 65. You can delay it, turn it down entirely, or take only part of it. But waiting or refusing comes with permanent penalties on your monthly payments, and you may face gaps in coverage that cost you more in the long run. The decision depends on whether you are still working, whether your employer offers health insurance, and how long you expect to live — not on what Medicare wants you to do.

The key rule: if you do not sign up during your initial enrollment window (the seven months around your 65th birthday), you will pay a late penalty for as long as you have Medicare. That penalty does not go away. For most people, the math works out to take it on time, but there are real situations where waiting makes sense.

Key Takeaways

You can refuse Medicare or delay it past 65, but you will pay a permanent monthly penalty if you do not enroll during your seven-month initial enrollment window.
If you are still working and your employer has 20 or more employees, you can delay Part B without penalty as long as you enroll within eight months of leaving that job.
Part A (hospital insurance) has no monthly premium for most people, so there is usually no financial reason to refuse it.
Delaying Medicare makes sense only if you have employer coverage that is as good as or better than Medicare, and you enroll in Medicare within the allowed window after that coverage ends.
The penalty for late enrollment is 10 percent per year for Part B and 1 percent per month for Part D (prescription drugs), and these penalties are permanent.

When you can delay Medicare without penalty

You can delay Part B (medical insurance) and Part D (prescription drug coverage) without penalty if you have health insurance through your current job or your spouse's current job. The employer must have at least 20 employees. This is called the eight-month special enrollment period.

Here is how it works: you do not enroll in Part B or Part D while you are working and covered by that employer plan. When you leave the job or lose that coverage, you have eight months to sign up for Medicare Part B and Part D without paying a late penalty. You must enroll within that eight-month window, or the penalty applies for life.

Part A (hospital insurance) is different. You can delay Part A if you have employer coverage, but there is usually no reason to — Part A has no monthly premium for most people, so delaying it saves you nothing and risks a gap in coverage if something goes wrong.

What happens if you refuse Medicare entirely

You can refuse to enroll in Medicare at 65 and keep your employer insurance instead. But once you leave that job or that insurance ends, you have a limited window to enroll without penalty. If you miss that window, you will pay a permanent penalty on Part B and Part D for the rest of your life.

The penalty is 10 percent of the standard Part B premium for each 12 months you were may be able to access but not enrolled. If you delay Part B for three years, your penalty is 30 percent of the Part B premium, added to your bill every month forever. The same logic applies to Part D: 1 percent of the average premium per month of delay.

There is no penalty for delaying Part A if you have employer coverage, but once you are no longer covered by an employer plan, you should enroll in Part A right away. Gaps in Part A coverage can leave you responsible for the full cost of a hospital stay.

The cost of waiting if you do not have employer coverage

If you turn 65 and do not have employer insurance, you should enroll in Medicare during your initial enrollment window. Waiting costs you money in two ways: the permanent late penalty, and the gap in coverage itself.

Your initial enrollment window is the three months before the month you turn 65, the month you turn 65, and the three months after. That is seven months total. If you miss this window and do not have a may have access to reason (like employer coverage), you will pay the late penalty for life.

Even if you think you do not need insurance, Part A is worth taking at 65 because it has no monthly premium for most people. Part B and Part D do have premiums, but the penalty for delaying them often costs more than the premiums themselves, especially if you live a long time.

Special situations where you might refuse Medicare

Some people with very low income may may have access to for Medicaid instead of Medicare, or for both at the same time. If you are in this situation, talk to your state Medicaid office before you turn 65 to understand how Medicare enrollment will affect your Medicaid coverage. The rules vary by state.

Some people are covered by the Veterans Health Administration (VA) or TRICARE (military family coverage) and may not need Medicare. But even if you have VA or TRICARE coverage, you should still enroll in Part A at 65 because Part A has no premium and can cover services that VA or TRICARE do not. Talk to your VA or TRICARE representative before you turn 65.

If you are still working past 65 and your employer has fewer than 20 employees, Medicare becomes your primary insurance, not secondary. In this case, you should enroll in Medicare on time to avoid the late penalty.

How to delay or refuse Medicare

To delay Medicare, you do not have to do anything — straightforward do not sign up. But you must keep track of your enrollment window and make sure you enroll before it closes if you want to avoid the penalty.

If you have employer coverage and want to delay Part B and Part D, you should still enroll in Part A during your initial enrollment window. You can do this online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office.

When you are ready to enroll after delaying, you will need to show proof that you had may have access to employer coverage. Keep your insurance card, a letter from your employer's benefits office, or a pay stub that shows the name of your health plan. You will need this to avoid the late penalty.

What to ask your doctor or Social Security

Before you turn 65, talk to your doctor about whether Medicare will cover the care you need. Ask whether your current doctors take Medicare and whether your prescriptions are covered under a Medicare Part D plan.

If you are still working, ask your employer's benefits office whether your health plan is considered "creditable coverage" for Medicare purposes. This is the official term for coverage that is as good as Medicare. If it is, you can delay Medicare without penalty.

Call Social Security at 1-800-772-1213 at least three months before you turn 65 to discuss your options. Social Security handles Medicare enrollment, and they can tell you whether your situation qualifies for a delay and what your penalty would be if you miss your enrollment window.

Frequently Asked Questions

What if I turn 65 and do not enroll, but then change my mind a year later?

You can enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage starts July 1. But you will owe the late penalty for the year you missed, and that penalty is permanent. It is better to enroll on time or during your special enrollment period if you have employer coverage.

Can I take Part A but refuse Part B?

Yes. Part A and Part B are separate. You can take Part A (hospital insurance) and refuse Part B (medical insurance). But if you refuse Part B and do not have other coverage, you will pay a late penalty if you enroll in Part B later. Part A has no monthly premium for most people, so there is no cost to taking it.

Do I have to take Part D if I do not take any other Medicare?

No. Part D is separate from Parts A and B. But if you do not take Part D when you first become may be able to access and do not have other prescription drug coverage, you will pay a late penalty when you do enroll. The penalty is 1 percent of the average Part D premium per month of delay.

What if I am on disability and turn 65 — do I have to take Medicare?

If you are on Social Security Disability Insurance (SSDI), you automatically move to Medicare at 65. You do not have a choice to refuse it. Your coverage changes from SSDI to Medicare Part A and Part B, but your monthly payment stays the same. You should still enroll in Part D for prescription drugs during your initial enrollment window to avoid a late penalty.

Will my employer insurance end when I turn 65?

Not automatically. Some employers continue coverage after 65, and some end it. Ask your employer's benefits office what happens to your coverage at 65. If your coverage ends, you have eight months to enroll in Medicare Part B and Part D without penalty. If your coverage continues, you can delay Medicare as long as you enroll within eight months of when that coverage actually ends.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.