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Is Medicare Mandatory?

Summary: For most, Medicare isn’t mandatory, but there are a lot of variables you’ll want to consider before choosing to opt-out. Without careful consideration, you will not only be underprepared for healthcare costs, but you may also face costly penalties if you sign up down the road. Estimated Read Time: 10 mins

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  1. Can You Opt-Out of Medicare Benefits?
  2. Is it Mandatory to Sign Up for Medicare at Age 65?
  3. Is Medicare Part A Mandatory?
  4. Is Medicare Part B Mandatory?
  5. Is Medicare Part C Mandatory?
  6. Is Medicare Part D Mandatory?
  7. Is Medicare Supplemental Insurance Mandatory?
  8. Is Medicare Mandatory if on Disability?
  9. Is Medicare Mandatory for Veterans?
  10. Is Medicare Mandatory for Social Security Recipients?
  11. Is Medicare Coverage Mandatory for Government Employees?
  12. Is the Medicare Wellness Exam Mandatory?
  13. How to Sign Up Whether Medicare Is Mandatory or Not

Qualified beneficiaries are automatically signed up for Original Medicare, but is Medicare mandatory? For some, it can make sense to forgo coverage until later, as there are options to delay coverage if you’re not ready when you first become eligible. However, there are still several factors to review before making a decision.

For example, if you do not have creditable coverage, you may get stuck paying penalties when you sign up for coverage. Furthermore, refusing Medicare coverage can lead to high healthcare expenses, depending on your situation.

There are also situations in which you may lose out on additional benefits if you do not enroll in Medicare coverage, and some employees may also be required to enroll in Medicare coverage to get the most out of their employer offerings.

If you’re not quite ready to join Medicare when you turn 65, there are some options to help delay your coverage. However, it’s essential to get the facts before making a decision as impactful as choosing to delay Medicare.

Your healthcare is essential, and Medicare is a complex subject. Luckily, our team is here to help. Find out when Medicare is and is not mandatory below to make an informed decision, cover your healthcare costs, and avoid regrets.

Can You Opt-Out of Medicare?

Are any parts of Medicare mandatory? No! Medicare is not mandatory.

It’s possible to opt out of Medicare coverage when you turn 65. However, several factors can come into play here. You can opt out of Medicare if you have health insurance through an employer. However, you must receive employer coverage that qualifies to avoid paying the Medicare Part B late enrollment penalty.

Alternatively, buying Marketplace insurance after turning 65 is costly, especially for Medicare beneficiaries. Once you are Medicare eligible, you’ll lose your subsidy. Therefore, Medicare makes the most financial sense for most.

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It’s also important to note that exceptions still apply. For specific government employees, Medicare is mandatory for their employer benefits.

Is it Mandatory to Sign Up for Medicare at Age 65?

You are not required to sign up for Medicare Part A. This coverage takes care of hospital-related expenses. However, if you want to have coverage for outpatient healthcare expenses, you’ll need to sign up for Medicare Part B.

Remember, Medicare Part B enrollment is important to avoid paying a penalty that never goes away if you sign up later. The best time for you to sign up is during your Initial Enrollment Period, which, simply put, means as soon as you become eligible for Medicare benefits.

Your Initial Enrollment Period begins three months before your sixty-fifth birthday and ends three months after you turn 65. Thus, you have seven months to enroll.

If you choose to enroll after your Initial Enrollment Period ends, you could face a penalty. Even worse, delaying Part B could result in having to wait for the General Enrollment Period, which adds to the cost of your late penalty.

Again, those delaying Part B may be able to do so without a penalty if they are working for a company with more than 20 employees. You’ll just need to have employer coverage that qualifies as credible coverage.

Is Medicare Part A Mandatory?

Medicare Part A is not mandatory for most people. However, it’s beneficial for eligible individuals to sign up as soon as possible in most cases because, technically, there may be a penalty if you look to sign up later on.

Enrolling in Part A is mandatory for those receiving Social Security to keep their benefits. Part A inpatient coverage comes at no cost to most Americans, and if you’ve worked 40 or more quarters (ten or more years), you’ll get it premium-free if you enroll when first eligible.

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But for those who wish to contribute to a Health Savings Account after age 65, delaying Medicare Part A makes sense. Once Part A is active, you can’t add to a Health Savings Account. Still, you’ll want to be sure you can afford rising healthcare costs should a significant health concern arise.

It’s also worth noting that Medicare Part A coverage is paid for in part by your taxes. You can also enjoy a wide range of coverage from healthcare expenses that continue to rise at an alarming rate.

Is Medicare Part B Mandatory?

Medicare Part B is not mandatory. You can delay enrollment or never enroll in Part B at all if you wish. Here’s why you may want to think twice about delaying or forgoing coverage:

We’ve already touched on this above, but you will have a penalty to pay, and it never goes away if you sign up after delaying enrollment.

Part B benefits cover outpatient expenses, and with more and more Americans avoiding the doctor because of rising medical costs, it’s important to stay covered.

After using Original Medicare benefits, you may still be stuck with lingering costs. These expenses can be paid by Medicare Supplement plans, but if you don’t have both Medicare Parts A and B, you won’t be able to enroll in such supplemental coverage.

It’s also worth noting that in order to enroll in Medicare Part D Prescription Drug Plans, you’re going to need to have coverage from at least Part A or Part B.

Should you choose to enroll in a Medicare Advantage plan instead of Medigap, you’ll need to have both parts of Original Medicare to do so as well.

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Medicare Part B covers physician visits, lab tests, outpatient surgeries, and even Durable Medical Equipment. You may even receive coverage for medication if it’s received in an outpatient setting.

Is Medicare Part C Mandatory?

Medicare Part C is entirely optional, and you’ll need to choose to enroll in a Medicare Advantage plan by choosing among carriers available in your area. Furthermore, you will need to choose either Medicare Advantage or Medigap coverage, as you cannot enroll in both at the same time.

Is Medicare Part D Mandatory?

While Medicare Part D is voluntary, you’re going to want to consider enrolling as soon as you are eligible for Medicare coverage. This is because if you delay Medicare Part D enrollment, you’ll also face a Part D late-enrollment penalty.

Drug coverage is great to have, even when you don’t have a monthly prescription. When you get a prescription for an antibiotic or another temporary drug, it’s also nice to know you have coverage should your healthcare needs change in the future.

Remember, if you choose to enroll at a later date, you’ll have a penalty, so you’ll end up paying more later on if you develop a need for medication due to a health condition. However, if you have a prescription plan through another carrier and it meets specific standards, you can avoid paying the penalty.

Is Medicare Supplemental Insurance Mandatory?

Medicare Supplement plans aren’t mandatory for anyone. Also known as Medigap plans, they help you cover the leftover expenses that can occur when using Original Medicare benefits and are offered by private companies, not the federal government.

While there is no penalty for signing up for a Medicare Supplement plan as soon as you’re eligible, you’re still likely to pay a higher premium for doing so. Furthermore, you might not even qualify for coverage at all.

This is because when you delay enrolling in Medigap, you are no longer protected from answering underwriting questions. These medical questions will come from private carriers, and depending on your medical history, you can either be denied coverage altogether or provided coverage with an elevated premium.

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Is Medicare Mandatory if on Disability?

If you receive Social Security Disability benefits for 24 months, you’ll be automatically eligible for Original Medicare, as well as enrolled in the coverage. Depending on income levels, you may have monthly premiums to pay, and while coverage is optional, it comes with a caveat:

  • If you want to cut Medicare Part B, you can do so and only incur the previously mentioned risks. However, if you ditch Part A coverage, you’re going to be required to use all of the SSDI benefits you’ve been given.

This is a very important consideration and is a core reason that most simply keep their Original Medicare coverage when on disability. You should also note that if you’re Medicare-eligible and you delay enrollment without creditable coverage, you will get a penalty.

The exception for such penalties is for those receiving benefits from Medicare Extra Help or Medicaid programs.

Is Medicare Mandatory for Veterans?

If you’re a veteran receiving VA benefits, Part B isn’t necessary in many cases. However, the U.S. Department of Veterans Affairs (VA) suggests signing up for both Medicare Part A and Part B.

Veterans have a more extensive network of doctors and services when they have Medicare and VA benefits. By choosing to opt-out or delay benefits, veterans may be penalized when they need Medicare. You’ll also miss out on receiving coverage for healthcare services outside of VA facilities if you choose not to enroll in Original Medicare.

On the other hand, Medicare Part B is mandatory for Veterans qualifying for TRICARE in order to keep their benefits. To enroll in Part B, you need Part A or at least a Part A effective date. Also, it’s essential to keep your information in DEERS current.

Active-duty members and family members can have Part A, TRICARE, and delay Part B. However, once active-duty status ends, you will need Part B to keep your TRICARE coverage.

Is Medicare Mandatory for Social Security Recipients?

Medicare is required for Social Security recipients. Specifically, Part A is mandatory. Otherwise, you’ll forfeit your Social Security benefits. But remember, if you choose not to keep Part A coverage, you’re also going to have to pay back all the SSDI benefits you’ve received so far.

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Is Medicare Coverage Mandatory for Government Employees?

Medicare is mandatory for those hired or rehired as state or local government employees after March 31, 1986. Those under a Section 218 Agreement already receive coverage for Medicare. On the other hand, Medicare Qualified Government Employees don’t receive Social Security coverage for their services, but they must pay FICA’s Medicare-only portion.

Is the Medicare Wellness Exam Mandatory?

Once a beneficiary turns 65 and begins Medicare coverage, they’ll be eligible for their Welcome to Medicare visit. This visit is an initial physical exam, covering some vaccines, blood pressure, height, and weight measurements, an essential vision screening, and body mass index calculation.

This appointment isn’t mandatory. If you go on your Welcome to Medicare visit, you must do so within the first 12 months of enrolling in Medicare.

How to Sign Up Whether Medicare Is Mandatory or Not

As you can see, there are many instances in which Medicare may not be mandatory, but it’s still advantageous. Still, there are a lot of considerations and scenarios to work through, and assistance can help you during the process.

Here at MedicareFAQ, we’re here as an educational resource and can help you sign up for your coverage. Our services are free but come with no obligation.

If Medicare is mandatory for your healthcare or you simply qualify and wish to explore your options, our licensed insurance agents can help. Contact us today or press the compare plans button below.

Sources

MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.

  1. Fact Sheet: Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65, CMS. Accessed August 2023.
    https://www.cms.gov/Outreach-and-Education/Find-Your-Provider-Type/Employers-and-Unions/FS3-Enroll-in-Part-A-and-B.pdf
  2. Mandatory Medicare Coverage, SSA. Accessed August 2023.
    https://www.ssa.gov/slge/mand_med_cov.htm
  3. Why more Americans are putting off going to the doctor, PBS. Accessed August 2023.
    https://www.pbs.org/newshour/show/why-more-americans-are-putting-off-going-to-the-doctor
  4. Medicare Coverage for People with Disabilities, Center for Medicare Advocacy. Accessed August 2023.
    https://medicareadvocacy.org/medicare-info/medicare-coverage-for-people-with-disabilities/
  5. SSDI and Medicare: 5 Things You Need to Know, NCOA. Accessed August 2023.
    https://www.ncoa.org/article/ssdi-and-medicare-5-things-you-need-to-know
Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Medicare Insurance Agent, she brings a wealth of knowledge and expertise to her writing.
Ashlee Zareczny

Ashlee Zareczny

Compliance Manager
Ashlee Zareczny is the Compliance Manager for MedicareFAQ. As a licensed Medicare agent in all 50 states, she is dedicated to educating those eligible for Medicare by providing the necessary resources and tools. Additionally, Ashlee trains new and tenured Medicare agents on CMS compliance guidelines. Ashlee is a Medicare expert who specializes in Medicare Supplement, Medicare Advantage, and Medicare Part D education.

2 thoughts on "Is Medicare Mandatory?"

  1. I’m angry. I received an inheritance in 2020 and both my husband and I are being charged 340 dollars each for B. I’m thinking; 1. Medicare should not be tied to social security, that SS money is mine, I worked 45+ years paying into it. 2. A one time inheritance should not be considered in my cost of part B, I already paid my taxes on that $ and this is double taxation which is against the law. Is this another way for the govt to grab retirees investments, Ira money that we saved for retirement! If I still lived in Washington state there would be a premium in addition to the cost of B. For an advantage plan. How is this better than private insurance.

    1. Jana, I understand your frustrations. Unfortunately, any inheritance you receive is considered taxable income for the year it was received. If you would like to try and dispute this with Medicare, you can file a dispute at Medicare.gov and it will be reviewed on a case-by-case basis.

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