Last Updated on by
Medicare is not mandatory. There are options to delay coverage if you’re not ready when you first become eligible. But, if you don’t have creditable coverage, you’ll get stuck with penalties! If you’re not quite ready to join Medicare when you turn 65, there are some options to help delay your coverage. Find out when Medicare is and is not mandatory below.
Can You Opt-Out of Medicare
Now, delaying Medicare can result in penalties, and buying the Affordable Care Act insurance after 65 is costly. For many, buying Medicare makes the most financial sense.
Opting-out is an option if you have employer benefits and aren’t retiring; but, if you’re retiring, you’ll need coverage.
Below we’ll take a moment to discuss the different factors.
Is it Mandatory to Enroll in Medicare at Age 65?
For some, not enrolling in Medicare can be a poor decision. Especially if delaying enrollment will cause a Part B late-enrollment penalty.
But, some people won’t be penalized for delaying enrollment. Let’s take a look at a few different scenarios.
Factors that come into play:
Are you retired?
- If retired, you more than likely need to enroll at 65 years old.
Are you still employed?
- If the company has less than 20 employees, you should enroll as soon as possible. If over 20 employees, you may have options.
What is your group employee health coverage like?
- If you have great coverage, you can keep using it as your primary insurance and use the Medicare coverage as secondary insurance.
The Initial Enrollment Period begins three months before turning 65 years old and ends three months after turning 65 years old. You have seven months to enroll.
If you choose to enroll after the Initial Enrollment Period ends, you could face a penalty. Or worse, delaying Part B could result in having to wait for an eligible enrollment period, which adds to the cost of your late penalty.
What Parts of Medicare are Mandatory
Part A comes at no cost to most Americans. If you have 40 or more quarters (ten or more years) of employment, you’ll have Part A free. Those that qualify for free Part A should enroll once eligible.
But, if you want to contribute to a Health Savings Account after age 65, delaying Part A will make sense. Once Part A is active, you can’t add to a Health Savings Account. Those that get Social Security benefits will need to take Part A unless they want to forfeit benefits.
You must pay for Part B and D; these are voluntary parts. But, if you delay either enrollment, you’ll have late fees.
Is it Mandatory to Have Medicare Part B
Part B is optional, but penalties can be high if you wait too long. This covers physician visits, lab tests, outpatient surgeries, and even medical equipment. If you choose to delay Part B during your Initial Enrollment Period, you’ll have to wait for enrollment until your General Enrollment Period starts. This means that you would have to wait nearly a year and a half to have any vital coverage
Penalties happen when delaying Part B; they can charge you up to 10% above the standard premium for a period of every 12-months that you don’t carry coverage. Also, the more time that passes the higher the penalty.
When Did it Become Mandatory for Medicare Beneficiaries to Have Part D?
Part D is optional. This is your drug plan and can help pay for prescriptions. Drug coverage is great to have, even when you don’t have a monthly script. When you get a prescription for an antibiotic or another temporary drug, it’s nice to know you have coverage.
If you choose to enroll at a later start date, you have a penalty. If you have a plan through another carrier and it meets specific standards, you don’t have a penalty.
Those that take Medication may find even more financial relief by selecting the mail order pharmacy option through the plan. Mail order options generally mean a three month supply at a two-month or less cost, though this isn’t always the case.
Is Medicare Mandatory if on Disability
People that get Social Security Disability benefits are automatically eligible for Part A. Medicare disability eligibility begins after 25 months of disability. Depending on income levels, you may have monthly premiums to pay for your Part B, C, and D.
This amount that you would pay would be reliant on your monthly income. If you’re Medicare-eligible and you delay enrollment without creditable coverage, you WILL get a penalty.
The only instance where a penalty may receive a waiver is when you get extra help or Medicaid.
Is Medicare Mandatory for Veterans
If you’re a veteran that gets VA benefits, Part B isn’t necessary. But, the Veterans Affairs suggests both Part A and Part B. Veterans have a more extensive network of doctors and benefits when they have Medicare and VA.
By choosing to opt-out or delay benefits, veterans may potentially have penalties when they need Medicare.
For veterans that qualify for TRICARE, you must have Part B to keep your 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. Then, once active duty status ends, you need Part B to keep TRICARE.
Are Medicare Wellness Exams Mandatory
Once a beneficiary turns 65 years old and begins Medicare coverage, they’ll be eligible “Welcome to Medicare” visit. This is an initial physical exam that will cover some vaccines, blood pressure, height and weight measurements, a basic vision screening, and calculations of your body mass index.
These appointments are not mandatory. If you go to a wellness visit, you must complete the visit within the first 12 months of joining Medicare.
Get Help Finding a Medigap Plan Today
When you choose to enroll in Medicare through our company, we’ll answer all your questions. We can help you find the best rates and walk you through the enrollment process.
Call us today at the number above to speak with one of our agents. Our team is here to help you to find the best plan. Feel free to complete an online rate form to compare prices!