Is Medicare Coverage Mandatory at Age 65?

One of the most popular questions for people who are about to become eligible for Medicare is whether or not Medicare enrollment is mandatory at age 65. If you’ve been wondering about this, then read on to learn more.

Enrollment Is Not Mandatory at Age 65

Medicare is a federal health insurance program for people who are 65 or older (U.S. citizens or legal permanent residents living in the U.S. for the past five years), certain younger people with qualifying disabilities and people with end-stage renal disease or ALS. Being eligible to enroll in Medicare coverage doesn’t mean that you must enroll. Note that delaying or missing enrollment in Medicare when you are first deemed eligible may result in lifetime penalties, delays in benefits or limited coverage. If you’re eligible to enroll in Medicare, the decision to move forward with your enrollment application depends on a number of factors. For those who are currently employed, the primary factor is the size of your employer. There are other factors that influence enrollment decision making and delaying enrollment; learn more about those on our Enrollment page.

Current Employment Status May Affect Your Enrollment

If you are currently working, then you need to determine a few things before you take steps to enroll in a Medicare plan. One of the most important questions to ask your manager or human resources department is how many employees your current employer has on staff. This number impacts when you may need to enroll in Medicare once you reach the age of 65. You should also ask human resources about your current health benefits and if your employer’s group health insurance coordinates with Medicare.

If your current employer has fewer than 20 employees, then you should enroll in Medicare as soon as you are eligible as Medicare is the primary payer in such circumstances.

If the employer through which you get your health insurance (either your own or your spouse’s) has more than 20 employees, then your coverage is considered creditable. This means you need to assess your coverage options, weighing your health benefits provided by creditable coverage against those provided by Medicare Part B. In such a case, you can often remain on your employer’s group health insurance coverage and delay your enrollment into Medicare Part B until either your retirement or once you determine Medicare coverage provides better value. It’s quite common for people who work past 65 for a large employer to enroll in Medicare Part A (which incurs no premium cost if you or your spouse have worked for 40 quarters or 10 years) while delaying enrollment in Part B (which incur premium costs upon enrollment). After turning 65, you can voluntarily enroll in Medicare Part B at any time you choose if you remain active at work and maintain creditable coverage through your employer.

Consider the Quality of Employer-Sponsored Coverage

Some people who qualify for health insurance through their employers are quite satisfied with their care and options. In such a case, it’s not necessary to pursue Medicare coverage until retirement. However, as you may discover by looking over the details of your plan, it’s possible that Medicare may provide better coverage for your situation. In this case, it’s okay to apply for Medicare if you’re still employed as long as you’re age 65 or meet other requirements outlined earlier in this blog post. You could use a combination of the two health insurance plans to cover any medical costs that you may incur or research to determine if a Medicare Advantage or Medicare Supplement plan might make sense.

If you have additional questions about enrolling in Medicare, or how to make the most out of your plans, our knowledgeable Medicare insurance agents can help. Contact a member of our team today for more information on how you can get the optimal coverage possible with your Medicare plan. At Medicare Portal, our local Medicare insurance agents are here to help you at every step of the way.

Scroll to Top