How to opt out of Medicare at 65?

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To opt out or decline Medicare at 65, your steps depend on whether you are automatically enrolled or if you simply choose not to sign up yet.

If You Are Not Receiving Social Security

  • Do nothing: If you are not collecting Social Security or Railroad Retirement benefits when you turn 65, enrollment is not automatic. Simply do not apply for Medicare or Part B if you plan to stay on an active employer health plan.
  • Check employer size: Ensure your current employer has 20 or more employees so your group health coverage qualifies to delay Medicare without late penalties.
  • Stop HSA contributions: Stop contributing to a Health Savings Account (HSA) at least six months before turning 65 to avoid tax penalties, as Part A can date back up to six months retroactively.

If You Are Automatically Enrolled

  • Return the Medicare card: If you already receive Social Security benefits, you will get a welcome packet and a red, white, and blue Medicare card automatically.
  • Follow the instructions: Follow the specific directions included in your welcome packet to decline or drop Part B, which involves signing the back of the notice and mailing your Medicare card back.
  • Contact Social Security: If you have questions or need help cancelling, contact the Social Security Administration directly before your official coverage start date. Note that if you are taking Social Security retirement benefits at age 65 or older, premium-free Part A is generally mandatory and cannot be dropped unless you also repay all Social Security benefits received.

What happens if you don't want Medicare when you turn 65?

If you do not want Medicare when you turn 65, you can delay enrollment without penalty, provided you have qualifying health coverage like an employer group plan.

What Happens Without Other Coverage

  • Late Enrollment Penalties: If you delay Medicare Part B without qualifying employer coverage, you pay a lifetime 10% penalty for every 12-month period you wait.
  • Part D Penalties: Delaying prescription drug coverage without creditable coverage adds a permanent 1% penalty per month to your base premium.
  • Coverage Gaps: If you miss your Initial Enrollment Period and lack a Special Enrollment Period, you must wait for the General Enrollment Period (January 1 to March 31), creating a gap before coverage starts.

What Happens If You Have Other Insurance

  • Employer Coverage: If you or your spouse work and have active group health insurance from an employer with 20 or more employees, you can delay Part B penalty-free.
  • Automatic Part A: If you already collect Social Security benefits when you turn 65, you are automatically enrolled in premium-free Part A. You cannot drop Part A without withdrawing your Social Security application and repaying benefits.
  • HSA Contributions: You must stop contributing to a Health Savings Account (HSA) at least six months before applying for Medicare to avoid tax penalties.

Can I opt out of Medicare completely?

Yes, you can drop or decline Medicare coverage, but doing so completely if you already receive Social Security benefits requires you to also give up your Social Security retirement payments.

Dropping or Declining Coverage

  • If you pay a premium for Part A or Part B: You can drop Medicare Part B or a premium-based Part A at any time by filling out form CMS-1763 or contacting the Social Security Administration.
  • If you get premium-free Part A: You can only decline or withdraw from premium-free Part A if you also withdraw from your monthly Social Security or Railroad Retirement Board benefits and pay back all the cash benefits you have already received.
  • Automatic enrollment: If you are automatically enrolled when turning 65 because you already collect Social Security, you must follow the instructions in your welcome packet to return your Medicare card and cancel coverage.

Important Risks

  • No reimbursement: You will pay 100% out-of-pocket for medical care since doctors cannot bill Medicare for your care.
  • Late penalties: If you decide to sign up again later, you may face permanent monthly late enrollment penalties for Part B.
  • Coverage gaps: You typically have to wait until the next General Enrollment Period (January 1 to March 31) to re-enroll.

Is it mandatory to start Medicare at 65?

No, it is not mandatory to start Medicare at age 65.

You are not legally required to sign up for Medicare at 65, but delaying it depends heavily on your current health insurance situation.

When You Can Delay Medicare

  • Active Employer Coverage: If you or your spouse are still working and have health insurance through an employer with 20 or more employees, you can delay enrolling in Medicare without facing late penalties.
  • Special Enrollment Period: When that active employment or group coverage ends, you will get a Special Enrollment Period to sign up for Medicare penalty-free.

When You Must Enroll at 65 (or Risk Penalties)

  • No Other Coverage: If you do not have job-based insurance through a large employer (20+ workers) when you turn 65, you should sign up immediately to avoid gaps in coverage and permanent late-enrollment penalties.
  • Small Employers: If your employer has fewer than 20 employees, Medicare generally becomes your primary insurance at 65, meaning you should enroll even if you have the employer's plan.
  • COBRA or Retiree Coverage: COBRA and retiree health plans do not count as active employer coverage, so you must sign up at 65 to avoid penalties.
  • Automatic Enrollment: If you are already collecting Social Security benefits when you turn 65, you will be automatically enrolled in Original Medicare.

You can learn more about rules for working past 65 directly through official resources.

Can you refuse to be on Medicare?

You can refuse or delay parts of Medicare, but whether you can refuse it entirely depends on if you receive Social Security benefits.

Refusing Part A (Hospital Insurance)

  • If premium-free: You cannot refuse Part A if you qualify for premium-free coverage and already receive Social Security benefits. To decline premium-free Part A, you must withdraw from Social Security and repay all benefits received.
  • If you must pay a premium: You can choose to drop or refuse premium-paid Part A by submitting a signed request to the Social Security Administration.

Refusing Part B (Medical Insurance)

  • Voluntary nature: Part B is optional and requires a monthly premium, so you can decline or drop it.
  • Automatic enrollment: If you already get Social Security when you turn 65, you are enrolled automatically. You must follow the instructions on the back of your red, white, and blue Medicare card to decline Part B.
  • No Social Security yet: If you are not collecting Social Security and want to delay Part B because you have active employer coverage, you simply do not sign up during your initial window.

Risks and Penalties

  • Late penalties: Delaying Part B or Part D without "creditable" coverage (like an active employer plan) causes permanent late-enrollment penalties when you sign up later.
  • Coverage rules: COBRA and retiree plans do not count as active employer coverage to avoid Part B penalties.
  • Most users on Reddit agree that while you can technically delay or decline parts of Medicare, doing so without alternative qualifying insurance is risky and generally not recommended.

Do I Have To Take Medicare at 65?

9 related questions found

What is the penalty for not enrolling in Medicare at 65 years old?

The penalty for not enrolling in Medicare on time at age 65 depends on which part of Medicare you delay and how long you go without coverage.

Medicare Part A Penalty (Hospital Insurance)

  • Who it affects: Most people get Part A for free because they paid Medicare taxes while working. If you have to pay a premium (because you worked fewer than 40 quarters), you face a penalty.
  • The cost: Your monthly premium increases by 10%.
  • How long you pay: You pay this higher price for twice the number of years you delayed signing up (for example, waiting two years means paying the penalty for four years).

Medicare Part B Penalty (Medical Insurance)

  • Who it affects: Anyone who delays Part B without qualifying for a Special Enrollment Period (such as having active employer coverage through a job).
  • The cost: Your monthly premium increases by an extra 10% for each full 12-month period you delayed enrollment.
  • How long you pay: You pay this penalty for life (as long as you have Part B).

Medicare Part D Penalty (Prescription Drug Coverage)

  • Who it affects: Anyone who goes 63 days or more without Part D or other "creditable" prescription drug coverage after turning 65.
  • The cost: You pay an extra 1% per month (12% per year) of the national base beneficiary premium for every month you were without coverage.
  • How long you pay: This added fee is permanent and stays on your monthly bill for as long as you have Part D.

Can I switch back onto regular Medicare and cancel medicare advantage?

Yes, you can cancel your Medicare Advantage plan and switch back to Original Medicare, but you can usually only make this change during specific enrollment windows.

When You Can Switch

  • Medicare Open Enrollment Period (October 15 – December 7): Changes made during this time take effect on January 1 of the following year.
  • Medicare Advantage Open Enrollment Period (January 1 – March 31): If you already have Medicare Advantage, you can switch to Original Medicare during this window, and your coverage starts the first of the month after your request is received.
  • Special Enrollment Periods: You may qualify to switch at other times if you experience specific life events, such as moving out of your plan's service area or your plan terminating its contract. You can review details on Special Enrollment Periods to see if you qualify.

How to Cancel and Switch

  • Enroll in a new plan: You can call 1-800-MEDICARE (1-800-633-4227) for live assistance to disenroll from your Advantage plan and return to Original Medicare. Alternatively, enrolling in a standalone Medicare Part D prescription drug plan will automatically disenroll you from your Medicare Advantage plan.
  • Contact your plan: You can also call your current Medicare Advantage provider directly to request cancellation before setting up your Original Medicare and Part D coverage.

Important Considerations

  • Prescription Coverage: Original Medicare does not include prescription drug coverage, so you will likely want to sign up for a separate Part D plan.
  • Medigap (Supplement Insurance): Original Medicare leaves you responsible for about 20% of medical costs. While you may want a Medigap policy to cover these costs, keep in mind that outside of a trial period or specific guaranteed-issue rights, most states allow insurance companies to use medical underwriting, meaning they can deny coverage or charge higher rates based on your health.

Is Medicare Part B really necessary?

Medicare Part B is optional legally, but it is practically necessary for most people to avoid massive out-of-pocket medical bills and lifetime late penalties.

✅ When You Need Part B

  • No other primary insurance: Covers 80% of outpatient care, doctor visits, and surgeries.
  • Wanting supplemental coverage: Required to buy a Medigap plan or join Medicare Advantage.
  • Specific military/retiree benefits: Mandatory if you use TRICARE For Life.

🗓 When You Can Delay Part B

  • Current active employment: Working and covered by an employer plan with 20+ employees.
  • Spouse's active employment: Covered by a working spouse's large employer plan.
  • Penalty protection: Creditable coverage lets you delay enrollment without late fees.

⚠️ Hidden Risks & Penalties

  • No out-of-pocket cap: Original Medicare alone leaves you exposed to unlimited 20% coinsurance.
  • COBRA and VA trap: Neither counts as active employer coverage to waive Part B late penalties.
  • Permanent late fee: Adds a lifelong 10% penalty to your monthly premium for every year delayed.

How do I remove myself from Medicare?

You can remove yourself from Medicare by contacting the Social Security Administration to file a formal request.

Steps to Disenroll

  • Get the Form: Download and complete the CMS-1763 Request for Termination Form.
  • Contact Social Security: Call Social Security at 1-800-772-1213 or visit your local Social Security office.
  • Schedule an Interview: Social Security often requires a brief interview or signed written request to review the financial and medical risks of dropping coverage.
  • Submit the Form: Deliver the signed paper form directly to your local office or mail it as instructed by Social Security (online submission is generally not available).

Important Rules to Know

  • Part A vs. Part B: You can drop Part B at any time. You can only drop Part A if you pay a monthly premium for it. If you get premium-free Part A because you or your spouse paid Medicare taxes while working, you generally cannot drop Part A without also withdrawing your Social Security retirement benefits and paying back all benefits received.
  • Effective Date: Your coverage ends on the last day of the month after the month you submit your request.
  • Penalties and Re-enrollment: Dropping coverage without qualifying alternative insurance (like large employer coverage) may lead to late-enrollment penalties and higher costs if you decide to re-enroll later.

Is there a penalty for switching from medicare advantage to regular Medicare?

There is no direct financial penalty for switching from a Medicare Advantage plan to Original Medicare.

However, you can face indirect financial costs or late penalties related to your prescription drug coverage or supplemental insurance.

Potential Cost and Penalties to Watch

  • Part D Late Enrollment Penalty: Most Medicare Advantage plans include prescription drug coverage. Original Medicare does not. When you switch back, you must sign up for a separate, standalone Part D prescription drug plan within 63 days. If you go 63 days or more without creditable drug coverage, you will face a permanent late enrollment penalty added to your monthly Part D premium.
  • Medigap Underwriting and Higher Costs: Original Medicare leaves you responsible for 20% coinsurance and has no out-of-pocket maximum. Many people buy a Medigap (Medicare Supplement) policy to cover these gaps. Unlike when you first turn 65, switching back to Original Medicare from an Advantage plan does not guarantee you can buy a Medigap policy at standard rates in most states. Insurance companies can use medical underwriting, meaning they can charge you more or deny you coverage based on your health history.

When Can You Switch?

You must make the change during allowed enrollment periods, such as the Annual Enrollment Period (October 15 – December 7) or the Medicare Advantage Open Enrollment Period (January 1 – March 31), unless you qualify for a Special Enrollment Period.