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What Happens if I Don’t Sign Up for Medicare at 65? Will I Be Penalized?

Medicare is government-run, tax-funded health insurance for individuals 65 and older. Some people may be eligible for Medicare at a younger age if disabled or diagnosed with End-Stage Renal Disease or ALS. If you do not sign up for Medicare when eligible, you may have to wait to enroll and be assessed a monthly late penalty.

Key takeaways:

The amount charged for the penalty depends on when you enroll and which part of Medicare you are enrolling in. Medicare coverage includes four main parts: hospital (Part A), medical (Part B), Medicare Advantage (Part C) and alternative to Medicare part A and B, and prescription drugs (Part D). This article will focus on Medicare enrollment for individuals turning 65.

Are there penalties for not signing up for Medicare?

If you elect not to have any Medicare coverage when you turn 65, no penalties are issued for opting out. Late enrollment penalties are added to the monthly premium should you decide to enroll in Medicare at a later date than your Initial Enrollment Period. However, when eligible, you cannot receive Social Security benefits without enrolling in Medicare Part A coverage. Since most people receive Premium free Medicare Part A at age 65, it is advisable to accept Medicare Part A coverage when you are eligible, which is age 65 for most people. Medicare Parts B, C, and D are optional.

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When is my Initial Enrollment Period?

You may enroll for Medicare (any part) during a seven-month window surrounding your 65th birthday. This window is known as the Initial Enrollment Period. If you miss this opportunity to enroll in Medicare, you may have to wait and pay a monthly late penalty. The longer you wait to enroll, the higher the penalty. Some exceptions may qualify you to avoid a late penalty.

Open enrollment for individuals turning 65 includes: three months before your 65th birthday, your birthday month, and three months after your 65th birthday. Your situation may vary, but this is the standard seven-month window for the Initial Enrollment period.

Medicare at 65 age gap enrollment chart

How am I notified of my Initial Enrollment Period?

You will be automatically enrolled in Medicare Part A and B when you turn 65 if you receive retirement or disability benefits. This is because your application for Social Security (or Rail Road Retirement Board) benefits also serves as your application for Medicare. If your application is approved, you will automatically receive Medicare Part A and B once eligible, but you can decide if you would like Part B coverage (since Part B requires a monthly premium). The Part B premium will be automatically deducted from your Social Security benefits unless you decline Part B. You must accept enrollment in Medicare Part A to receive your Social Security benefit.

You will receive a welcome packet from Medicare three months before coverage begins. Read the materials and make appropriate decisions within your allotted time. If you live in Puerto Rico or outside the U.S., you will still be automatically enrolled in Part A, but you must sign up for Part B.

You will need to sign up for Medicare coverage if you are still working and nearing your 65th birthday. You may sign up on the Social Security website, call 1-800-772-1213, or contact your local Social Security office. If you plan to continue working after turning 65 and have qualifying health coverage, you may be eligible for a Special Enrollment Period.

How to delay enrollment without a late penalty

You may sign up for Medicare after the Initial Enrollment Period without incurring a late enrollment payment in special situations. Specific forms must be completed and submitted to your local Social Security office if you qualify for a special enrollment period.

One of the most common qualifying reasons for a Special Enrollment Period is if an individual continues to work past 65 (while also maintaining qualifying health coverage). This situation also applies to covered spouses turning 65. Other situations such as volunteering and serving in a foreign country, natural disaster or declared emergency, being released from incarceration, or other unique circumstances could also qualify for a special enrollment period. To check if your situation qualifies, use this Medicare questionnaire: When Can I Sign up for Medicare?

What happens if you miss the enrollment period?

If you miss the seven-month window for your Initial Enrollment Period, you may still sign up for Medicare, but you may have to wait to enroll and will be charged a late penalty added to your monthly premium (except if you qualify for a special enrollment period.) The longer you wait to sign up, the higher your monthly late penalty will be. The exception to this is Medicare Part C. There is no late enrollment penalty for Medicare Part C, the optional program that provides an alternative to Medicare parts A and B coverage, but you cannot sign up without enrolling in Medicare Part A and B first.

What is a premium?

Medicare beneficiaries typically pay a premium each month, similar to private insurance, that ensures Medicare coverage for the enrolled person. This premium is paid monthly regardless of whether any care was utilized that month. The amount varies by part.

  • Part A Hospital. No premium if you or your spouse paid Medicare taxes while working for at least 10 years, known as “Premium-free Part A.” If you do not qualify for premium-free, you may purchase Part A for a premium.
  • Premium Part A. $278 or $506 in 2023. The amount depends on how long you or your spouse worked and paid Medicare taxes.
  • Part B Medical. $164.90 in 2023 may be more, depending on your income.
  • Part C Medicare Advantage. Varies by plan. Note that the Part B premium will continue to be charged monthly even if you elect Part C.
  • Part D Prescription Drug. Varies by plan.

If you cannot afford the monthly premium, there are cost-savings programs that can help.

How are Medicare late enrollment penalties calculated?

Let's review these examples taken directly from Medicare.gov. to explore how Medicare late enrollment penalties are calculated.

Premium Part A penalty is an additional 10% of the monthly premium if you pay a premium for Part A because you did not qualify for Premium-free Part A and delayed your enrollment. This additional 10% will be charged for twice the number of years that you delayed enrollment. If you qualify for Premium-free Part A, there is no late enrollment penalty because you are not paying a premium.

Example Premium Part A –If you waited two years to enroll in Premium Part A, you will pay the monthly premium plus 10% for four years.
  • $278 – 2023 Premium Part A but may be higher depending on income.
  • + 27.80 (10% of $278 late enrollment penalty).
  • $305.80 is your monthly Part A Premium until 2026, subject to change based on the current year’s premium amount.
  • Part B penalty is added to your monthly premium and will be part of your premium as long as you have Part B coverage. The Part B penalty is an additional 10% for every full year you were eligible for Part B but did not sign up. This is not a one-time late fee.

    Example Part B – You waited two years (24 months) to enroll in Part B and do not qualify for a special enrollment period. You will be charged a 20% late enrollment penalty plus the standard Part B monthly premium.
  • $164.20 – 2023 Part B standard premium.
  • + $32.98 (20% of the $164.90 late enrollment penalty).
  • $197.90 is your monthly Part B premium for 2023 (the amount is rounded to the nearest $0.10).
  • Part D penalty is charged at an additional 1% for each month (12% per year) that you delayed enrollment after qualifying and did not have creditable drug coverage. This penalty will continue for the duration of your Part D coverage and is added to your monthly premium.

    Example Part D – You did not enroll in Part D coverage until 14 months after you were eligible. You’ll be charged a 14% late enrollment penalty added to your monthly premium. Medicare calculates the amount from the “national base beneficiary premium.”
  • $32.74 is the “National base beneficiary premium” in 2023.
  • X 0.14 (14% penalty).
  • $4.60 (rounded to the nearest $0.10) penalty added to your Part D monthly premium for 2023.
  • Late Enrollment penalties overview

    This chart provides an at-a-glance view of the four Medicare parts, the late enrollment penalty associated with each Medicare part, and the duration for which the penalty is charged.

    Medicare coverageLate Enrollment penalty
    Duration of penalty
    Part A (Hospital Insurance)If you do not qualify for Premium-Free, a 10% surcharge of the monthly premium is added to your monthly premium2x the number of years of delayed enrollment
    Part B (Medical Insurance)10% of the standard monthly premium for every 12-month of delayed enrollment is added to your monthly premiumLifetime of Part B coverage
    Part C (Medicare Advantage)No penaltyN/A
    Part D (Drug Coverage)1% of the National Base Beneficiary Premium for each month that you delayed enrollment is added to your monthly premiumLifetime of Part D coverage

    Is there a way to reduce the penalty?

    If you are charged a late enrollment penalty, you must pay the premium and penalty or risk losing your Medicare coverage. There is currently no way to reduce a penalty after it's issued. However, you may request an appeal of the penalty by completing and submitting this form'Appeals Request Form. You must continue to pay the penalty while waiting for a decision.

    Medicare resources

    Speak with a Medicare specialist (1-800-MEDICARE or TTY 1-877-486-2048) who can help you understand when and how to enroll for Medicare. A licensed insurance agent may also help. It is important to receive adequate healthcare coverage at an appropriate time and avoid late penalties.


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