Is It Mandatory to Sign Up for Medicare at Age 65?
Some milestones come with clear instructions — like renewing your driver’s license or filing taxes.
But turning 65? That’s a little more complicated, especially when it comes to Medicare.
While over 65 million Americans are enrolled in Medicare, not everyone needs to sign up the moment they turn 65. In fact, in 2022, nearly half of all Medicare beneficiaries opted for Medicare Advantage over Original Medicare, showing just how many choices are out there.
If you want to avoid penalties and confirm your coverage, you need to know your options. At 65, is Medicare mandatory? Or can you wait?
Don’t worry: Senior Insurance Agency is here to break it all down and help you make an informed decision based on your specific situation.
About Medicare Enrollment at Age 65
For most Americans, age 65 marks the first opportunity to enroll in Medicare. At this age, individuals who are U.S. citizens or permanent residents (living in the U.S. for at least five years) become eligible for Medicare coverage. Individuals receiving social security benefits are automatically enrolled in Medicare Part A.
However, Medicare isn’t limited to those 65 and older. Some younger individuals may qualify earlier if they:
- Have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, making them eligible for disability benefits.
- Have End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant.
- Have Amyotrophic Lateral Sclerosis (ALS) (commonly known as Lou Gehrig’s disease), in which case Medicare coverage begins immediately upon receiving SSDI benefits.
The Initial Enrollment Period (IEP): Your First Window to Enroll
Your Initial Enrollment Period (IEP) is a 7-month window surrounding your 65th birthday:
- Begins: 3 months before your 65th birthday
- Includes: The month of your 65th birthday
- Ends: 3 months after your 65th birthday
This is your first opportunity to sign up for Medicare Part A (hospital insurance) and Part B (medical insurance) and get Part C, Part D or Medigap Insurance. If you miss this window and don’t have other coverage that allows you to delay, you may face late enrollment penalties, particularly for Part B and Part D (prescription drug coverage).
Enrolling during the first three months of your IEP means your Medicare coverage begins the month you turn 65. If you wait until your birthday month or later, your coverage will be delayed until the first of the month following your application, leaving you temporarily uninsured.
The IEP is one of the most important Medicare milestones. Knowing your enrollment window and whether you need to act can help you avoid costly mistakes and interrupted healthcare coverage.
Find Out If Medicare Is Required
When Medicare Enrollment Is Mandatory
If you’re already receiving Social Security or Railroad Retirement benefits, you’ll be automatically enrolled in Medicare Part A and Part B at age 65. Your Medicare card will arrive about three months before your birthday.
If you haven’t started collecting benefits, you must enroll manually during your Initial Enrollment Period (IEP) to avoid penalties.
If you don’t sign up for Medicare on time and don’t have employer-sponsored insurance, you may face lifelong penalties:
- Part B: A 10% penalty for every 12 months you delay, added to your monthly premium permanently.
- Part D: A 1% penalty per month without creditable prescription drug coverage, added to your premium.
- Part A: If you don’t qualify for premium-free Part A, delaying enrollment increases your monthly premium by 10% for twice the number of years you waited.
Missing Medicare deadlines can lead to higher costs and gaps in coverage. If you’re not automatically enrolled, sign up during your IEP to avoid late enrollment penalties.
When Medicare Enrollment Is Not Mandatory
If you’re still employed at 65 or older and have employer-sponsored health insurance through a group health plan, you may be able to delay Medicare enrollment — but it depends on your employer’s size.
- Employers with 20 or more employees: You can delay Medicare without penalties as long as your employer-sponsored coverage is considered creditable (meaning it meets Medicare’s minimum standards).
- Employers with fewer than 20 employees: Your employer may require you to enroll in Medicare, as Medicare becomes the primary payer for your healthcare. If you don’t enroll, you could face gaps in coverage. You need to talk to your employer in order to determine if you are able to delay Medicare enrollment without any gaps.
What Is Creditable Coverage?
Creditable coverage refers to employer-provided health insurance that is as good as or better than Medicare. If your employer plan qualifies, you can delay Medicare Part B and Part D without facing penalties. However, once you leave that job or lose your employer coverage, you’ll likely need to enroll in Medicare promptly.
Special Enrollment Period (SEP): Your Safety Net After 65
If you delay Medicare because you have creditable coverage, you’ll qualify for a Special Enrollment Period (SEP) when that coverage ends. This allows you to enroll in Medicare without penalties:
- Part B SEP: You have 8 months to enroll in Medicare Part B after losing employer coverage.
- Part D and Medicare Advantage (Part C) SEP: You have 63 days after losing coverage to sign up.
- Medigap SEP: The time frame varies — 6 months from enrolling in Part B, or 60 days in some cases.
Missing your SEP deadlines could result in permanent late enrollment penalties.
Learn If Medicare Is Mandatory
Considerations for Enrolling or Delaying Medicare
Before choosing, consider key factors like costs, how Medicare coordinates with other insurance, and whether your current healthcare needs are fully covered.
Cost of Premiums
Medicare costs vary depending on the coverage you choose and your income level.
- Medicare Part B: The standard monthly premium for 2025 is $185.00, but higher earners may pay more due to the Income-Related Monthly Adjustment Amount (IRMAA).
- Medicare Part D (Prescription Drug Coverage): Costs depend on the plan you choose and may also be subject to IRMAA if your income exceeds a certain threshold.
- Medigap (Medicare Supplement Insurance): Premiums vary based on age, location, and gender, and they can increase over time.
If you have employer-sponsored insurance, compare its costs against potential Medicare premiums to determine the financial decision.
Coordination with Other Health Insurance
If you have health insurance through an employer or a spouse’s employer plan, understanding who pays first is key:
- Employers with 20+ employees: Your employer’s plan is primary, and Medicare is secondary. You can delay Medicare without penalties.
- Employers with fewer than 20 employees: Medicare becomes primary, and your employer plan pays secondary. You may need to enroll in Medicare to avoid gaps in coverage.
Medicare often becomes the primary payer if you have retiree coverage, COBRA, or VA benefits, so delaying enrollment could lead to out-of-pocket expenses.
Personal Health Needs
Your healthcare needs should drive your Medicare decisions. Consider:
- Do you take regular prescriptions that may be cheaper with Medicare Part D?
- Do you need access to specialists or out-of-network providers?
- Would a Medicare Advantage or Medigap plan offer better benefits than your current insurance?
By weighing these factors, you can determine whether enrolling in Medicare at 65 or delaying coverage makes the most sense for your health and finances.
Know Your Medicare Enrollment Options
Medicare at 65: A Choice, to Consider
Medicare enrollment isn’t automatic for everyone at 65, and for some, delaying makes sense. But knowing when you must enroll — and the consequences of waiting too long — can mean the difference between seamless coverage and costly penalties.
Whether you’re working past 65, weighing employer-sponsored insurance, or simply unsure of your path forward, making an informed decision is key.
The good news? You don’t have to figure this medical insurance out alone.
Senior Insurance Agency is here to help you understand your options in Nevada, compare plans, and make for your future healthcare needs. With our help, avoid Medicare missteps that could cost you down the road.
Get in Touch with an Expert Today
Call us direct: (775) 829-9600
Frequently Asked Questions
In some scenarios, yes, you can switch Medigap plans after your initial Open Enrollment. However, the insurance company may conduct medical underwriting, which means your premiums will be based on your health status and other risk factors.
Some scenarios qualify you for a guaranteed issue right, which means insurers must cover you with no medical underwriting. This can happen if:
- You move to another state.
- Your insurance company goes bankrupt.
- You’ve lost employer-sponsored health coverage.
- You are involuntarily disenrolled from a Medicare Advantage plan.
Some states also have a Medigap birthday rule, which means you can switch plans around the time of your birthday each year. For example, you can switch Nevada Medicare supplement plans from 60 days after the start of your birth month each year.
If you don’t apply for Medigap during your open enrollment period, you can still apply for coverage during a future enrollment period. However, insurers are able to charge you higher premiums based on your health status or even deny you coverage.
No, Medigap plans do not cover prescription drug costs. If you are interested in prescription drug coverage, you will need to purchase a Medicare Part D plan. Like Medigap plans, Part D plans are offered by private insurance companies and regulated by the federal government, but they cover prescription drug costs.
Medigap plans are designed to be used with Original Medicare, covering out-of-pocket costs like deductibles and coinsurance. Medicare Advantage is a private alternative to Original Medicare that typically includes coverage for hospital stays, outpatient medical care, prescription drugs, and more.