Do You Automatically Get Medicare With Social Security?

An elderly woman talks with her doctor.

Social Security retirement benefits and Medicare coverage often go hand in hand. Many people might think that Medicare is the only option for health insurance coverage once you start receiving Social Security benefits. Others wonder whether you are automatically enrolled in Medicare if you receive Social Security. Enrollment in Medicare will happen automatically for some people, while others will need to sign up independently. If you are getting close to the eligibility age for Medicare, you should keep reading! We will tell you everything you need to know about getting Medicare benefits while on Social Security, as well as give you information on who qualifies for Medicare and how you can receive Social Security without enrolling in Medicare.

 

Medicare Enrollment For Social Security Beneficiaries

Whether or not you are automatically enrolled in Medicare depends on the timing of your Social Security benefits. Remember that you can start your Social Security retirement benefits at age 62 (or even earlier in a few cases). So, when are you eligible for Medicare? You do not become eligible for Medicare until age 65. So, if you are already receiving your Social Security benefits or Railroad Retirement Board (RRB) benefits when you get Medicare eligibility, you will be automatically enrolled in Original Medicare. This means that you will receive both Medicare Part A and Medicare Part B. If you live in Puerto Rico, you will only be automatically enrolled in Part A coverage.

Most people receive premium-free Part A coverage, although there is a monthly premium associated with Part B coverage. Remember that Medicare is funded with taxes you pay while working. As long as you have sufficient work history, you won’t need to pay a monthly premium for Part A coverage. For this reason, some people choose to opt out of their Part B benefits. Others choose to opt out because they are still working and are covered by a health plan through their employer. We will discuss this situation in more detail later in this article.

If you are not already receiving Social Security benefits upon reaching age 65, you will need to apply for Medicare and enroll on your own. Your initial enrollment period begins three months before your 65th birthday and runs until three months after your 65th birthday. Failure to sign up during this period can result in late enrollment penalties and higher premiums.

Remember that you will only receive Original Medicare by default whether you are enrolled automatically or sign up on your own. If you decide you wish to purchase a Medicare Advantage plan, Medigap supplement insurance, or a Medicare Part D prescription drug plan, you will need to sign up for one of those items on your own. You should sign up for these plans during your initial enrollment period as well because waiting until later can cost you more money.

 

Receiving Social Security Benefits Without Medicare

A nurse with a mask on talks on the phone.

You likely already know that you can start your Social Security benefits as early as age 62, and you don’t qualify for Medicare until you reach age 65. So, you can easily receive Social Security retirement benefits for three years before starting Medicare. However, once you hit your 65th birthday, you will be automatically enrolled in Medicare if you are already receiving Social Security. What happens if you want to get your Social Security benefits without getting Medicare? You can decline Medicare coverage and still receive Social Security.

Since there is a monthly Part B premium, many people choose to decline their Part B coverage and receive only Medicare Part A hospital insurance. With many Americans working later in life, many are still covered through an employer-sponsored health care plan when they reach age 65. If you are still receiving medical insurance through your employer when you become eligible for Medicare, some special rules apply. You can choose to delay your enrollment in Medicare, and you will not need to pay the late enrollment penalty. As long as you meet the requirements, you will qualify for a special enrollment period. This means that you can sign up for Medicare when you leave your employer, and you won’t be charged a penalty.

The exception mentioned above is what allows many people to receive Social Security without Medicare. They continue to receive their health coverage through their employer, even though they get a Social Security check each month. When they leave their current employment, they enroll in Medicare and begin to receive those benefits.

 

Medicare & Social Security Disability Benefits

We have mostly discussed the basics of Medicare as it relates to retirees and Social Security retirement benefits. However, you can also qualify for Medicare when you receive Social Security disability insurance (SSDI) benefits from the Social Security Administration (SSA). When receiving disability benefits, you will be automatically enrolled in Medicare once you have received disability benefits for a 24-month period. There is a 24-month waiting period before your Medicare benefits begin. However, that waiting period does not apply to some individuals with certain conditions.

If you have been diagnosed with end-stage renal disease (ESRD), you will qualify for Medicare benefits right away. Similarly, those with amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease will be eligible for immediate Medicare benefits. These diagnoses will qualify you for immediate benefits, but you must still apply for the benefits. You will not be automatically enrolled in coverage. You can contact your local Social Security office or Centers for Medicare & Medicaid Services office to apply for coverage. You can also apply for Medicare online through Medicare.gov, or you can call Social Security at 1-800-772-1213.

Some people also wonder whether you can receive Medicare if you are receiving Supplemental Security Income (SSI) benefits. SSI benefits do not qualify you for Medicare. If you receive SSI benefits, then you will likely qualify for Medicaid through your state’s Medicaid office. You should contact your state’s Medicaid office to get enrolled in that program.

 

Opting Out Of Medicare Coverage

An elderly woman looking through paperwork.

Many people wonder whether you can opt out of Medicare coverage. The answer is yes. Since most people receive premium-free Part A coverage, very few people decide to opt out of their Part A coverage. This provides hospital insurance at no cost to most qualifying individuals. Even if you are still employed and covered through a group health plan, Medicare Part A can provide some additional insurance that might help cover some of your health care expenses.

Many people ask, “Do I have to apply for Medicare Part B?” The answer is no. Since there is a premium associated with Medicare Part B, people choose to opt out of this coverage. There are a couple of important things to know about opting out. If you do not sign up for coverage during your initial enrollment period, you might end up paying more for coverage when you sign up. We will discuss more details in the next section about signing up for Medicare after your 65th birthday.

 

Enrolling In Medicare Past Age 65

There is nothing that prohibits you from enrolling in Medicare after age 65. You may have chosen to opt out of Medicare upon reaching age 65, but you decided later to enroll in coverage. First, you need to determine whether you qualify for a special enrollment period. If you were still employed and covered through a group health plan upon reaching age 65, then you will generally qualify for a special enrollment when your group plan ends. This means that you can sign up for coverage without any late enrollment penalties. You can also sign up for supplemental Medicare coverage without paying higher premiums or going through full medical underwriting.

If you do not qualify for a special enrollment period, you will need to sign up for coverage during a general enrollment period. There is an annual enrollment period each year during which you can sign up for Original Medicare, prescription drug coverage, or Medicare Part C – Medicare Advantage plans. Signing up during this period after your 65th birthday means that you will likely pay a late enrollment penalty and higher premiums.

When it comes to Medigap insurance, you could be completely denied coverage if you sign up late. Remember that these plans are managed by private insurance companies. While the law guarantees that your policy will be issued for the lowest premium if you sign up on time, waiting until after your 65th birthday means that you will go through the full underwriting process. These companies may charge you more for your policy based on your health history and pre-existing conditions. They could even completely deny your application. As you can see, the decision of when to apply for Medicare could have lasting effects for the rest of your life.

 

The Bottom Line

If you are already receiving Social Security upon reaching your 65th birthday, you will be automatically enrolled in Medicare coverage and will receive your Medicare card in the mail. If you are not receiving benefits, you will need to manually enroll in Medicare coverage. Waiting past your initial enrollment period might cost you more money in the form of higher premiums and late enrollment penalties. However, those who are still employed and covered through a group health plan will qualify for a special enrollment period that allows them to sign up late for Medicare without the additional fees or penalties. It is possible to completely opt out of Medicare even if you receive Social Security benefits, although very few people choose to do this.

 

Frequently Asked Questions

 

Can I collect Social Security and not have Medicare?

Yes, you can collect Social Security benefits and not receive Medicare. There are a couple of ways to do this. First, you can start your Social Security benefits early. If you start your benefits at age 62, you would not even qualify for Medicare yet. You could also choose to completely opt out of Medicare even though you receive Social Security. Finally, you could delay your Medicare benefits if you are still employed and covered through a group health plan. The last option allows you to sign up for Medicare when your group coverage ends without paying any penalties or late fees.

 

Does Medicare come directly out of your Social Security check?

Yes, most people choose to have their Medicare premium deducted directly from their Social Security check. However, this generally only applies to your Medicare Part B premium. If you choose to enroll in a Medicare Advantage plan or Medigap coverage, you will likely need to pay your insurance company each month to cover your premium.

 

When does Medicare kick in?

So, at what age does Medicare start? You become eligible for Medicare upon reaching age 65. You can also qualify for Medicare once you have received Social Security disability benefits for 24 months. Finally, those who are diagnosed with ESRD or ALS become eligible for Medicare right away. You will automatically be enrolled in Medicare if you are already receiving Social Security benefits when you reach age 65 or if you have received SSDI for 24 months. Otherwise, you will need to contact the Social Security office to enroll in coverage.

 

When do you have to start paying for Medicare?

You will need to start paying for Medicare as soon as you enroll in Part B coverage. Similarly, if you do not qualify for premium-free Part A coverage, you will need to pay as soon as you enroll. If you decide to enroll in Medigap, Medicare Advantage, or prescription drug coverage, your insurance company will give you the details on your premium amount and due date. Many people wonder, “When am I eligible for Medicare?” Generally, you become eligible at age 65 or after having received SSDI benefits for 24 months.

Elliot Marks

Elliot Marks

Elliot has spent years providing clear and concise information to help navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.