Do You Have to Sign Up For Medicare at Age 65?

When you turn 65, you may have the opportunity to enroll in Medicare. But is it mandatory to sign up? 

Technically, it is not mandatory to sign up for Medicare at 65 or at any age, for that matter. But it’s important to consider the situations in which you might decide not to enroll in Medicare at 65 so that you can make sure not to have any lapse in health insurance coverage or face a Medicate late enrollment penalty.

Do You Have to Sign up For Medicare if You Are Still Working?

The most common reason for people not signing up for Medicare when they turn 65 is because they are still working. Because they’re still working, they’re likely covered under their employer’s health insurance plan and are also unlikely to be collecting Social Security retirement benefits. 

Being covered under your employer-provided health insurance plan has no bearing on your Medicare eligibility. Medicare works in conjunction with several other types of health insurance – including health insurance provided by employers or unions – and won’t prevent you from enrolling. 

However, if you are not collecting Social Security retirement benefits at least four months before you turn 65, you will not be automatically enrolled in Medicare when you turn 65. In this case, you will have to manually sign up for Medicare when you’re ready to enroll. So, when should you sign up for Medicare if you are still working?

Many people choose to delay their Social Security retirement benefits until a later age when they can collect the full amount. If you choose to delay your retirement benefits, you must still sign up for Medicare manually once you’re eligible in order to avoid any late enrollment penalties (unless you have qualified group health insurance through an employer that employs more than 20 employees). 

Some people who are still working sign up for Medicare anyway, because Medicare can work as extra insurance along with an employer group health insurance plan. Some people may decide that Medicare is more affordable than their employer’s insurance, so they may continue working but disenroll from their group plan and enroll in Medicare instead. 

Can I Get Social Security and Not Sign up for Medicare?

Yes and no. Medicare Part B is optional. If you’re automatically enrolled in Medicare Part A, you will be automatically enrolled in Part B and then given the option of opting out.

You may still continue to receive your Social Security benefits without having Part B. 

What Happens if You Don’t Sign up for Medicare at 65?

When you near your 65th birthday, you will enter what is called your Initial Enrollment Period (IEP). This seven-month period begins three months before you turn 65, includes the month of your birthday and continues for three additional months. This is your first opportunity to sign up for Medicare. 

If you choose not to sign up for Medicare during your IEP, there are a few scenarios that might play out depending on your situation. 

• If you choose not to sign up because you are still covered by another qualified insurance policy, you may delay your Medicare enrollment until a later time and will not be subject to any late enrollment penalties once you do sign up. 
  
  
• If you do not sign up for Medicare at 65 you will be subject to a Medicare late enrollment penalty whenever you eventually sign up for Medicare at a later date.
  
  The late enrollment penalty for Medicare Part A is 10% of any premium that you owe, and remains in place for twice the number of years for which you were eligible to sign up but did not do so. There is no late enrollment penalty if you qualify for premium-free Part A.
  
  The late enrollment for Part B is 10% of the premium for each 12-month period for which you were eligible to enroll but did not, and it remains in place for as long as you remain enrolled in Part B. 
  
  
• Medicare Part D, which provides coverage for prescription medications, is optional but can also come with a late enrollment penalty if you don’t sign up when you’re supposed to. This penalty is a little more complex to calculate but remains in place for as long as you have Part D coverage.
  
  The Part D late enrollment penalty applies if you experience a stretch of at least 63 consecutive days without creditable drug coverage following your IEP and then later enroll in a Part D plan. 

Medicare Advantage plans (Medicare Part C) do not have a late enrollment penalty. You can sign up for a Medicare Advantage plan at any age, as long as you are already enrolled in Medicare Part A and Part B.

Medicare Supplement Insurance (Medigap) does not technically have a late enrollment penalty. However, if you enroll in a Medigap plan during your Medigap Open Enrollment Period, insurance providers aren’t allowed to use medical underwriting to determine your plan premiums or deny you coverage. Your Medigap Open Enrollment Period lasts for six months and starts as soon as you are 65 and enrolled in Medicare Part B.

There are also some Medicare Special Enrollment Periods that may apply to a someone who is turning 65. For example, if you are living overseas at the time of your 65th birthday and then later return to the U.S., you may qualify for a Special Enrollment Period for which you can sign up for Medicare with no late enrollment penalty.  

For questions about Medicare enrollment or eligibility, you can call 1-800-MEDICARE (1-800-633-4227). You can also use the Medicare eligibility estimate tool to find out when you’ll be eligible for Medicare.