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Do You Automatically Get Medicare with Social Security?

Are you navigating the complex world of Medicare and Social Security? You might find yourself with more questions than answers.

Do you automatically get Medicare with Social Security? Can you keep Social Security and opt out of Medicare? What’s the relationship between these two essential government programs, and when should you apply for them?

Whether you’re coming to retirement age or already receiving Social Security benefits, this article is for you. Understanding how Medicare and Social Security intersect is crucial for making informed decisions about your healthcare coverage. 

Can I Get Social Security without Medicare?

One of the most common questions is, “Can I receive Social Security benefits without enrolling in Medicare?”

When you’re automatically enrolled through your Social Security benefits, you’ll initially be enrolled in Medicare Part A. If you wish to have Part B as well, you’ll need to inform Social Security; otherwise, you might have to pay Part B premiums.

Medicare and Social Security, both government programs, often work together. Let’s consider how automatic enrollment in Medicare works.

How Does Automatic Enrollment in Medicare Work?

Enrollment in Medicare is automatic for most people receiving Social Security benefits. However, when to enroll depends on your circumstances: 

Turning 65: If you receive Social Security retirement benefits, you will be enrolled in Original Medicare three months before your 65th birthday.

End-Stage Renal Disease (ESRD): Individuals with ESRD may become eligible for Medicare benefits.

Lou Gehrig’s Disease (ALS): Those diagnosed with ALS can access Medicare benefits immediately.

Social Security Disability Insurance (SSDI): If you’ve been receiving SSDI benefits for 24 months, you automatically qualify for Medicare, regardless of the specific nature of your disability.

While most seniors won’t pay premiums for Medicare Part A, you will have a monthly Part B premium. In 2023, the standard Part B premium is $164.90 per month. The government can deduct your Part B premiums from your Social Security check. You can also use an alternative payment method.

A note for Puerto Rico residents receiving Social Security or RRB benefits: Automatic enrollment typically only covers Medicare Part A. To include Medicare Part B, you’ll need to apply separately.

Can You Get Social Security Without Signing Up for Medicare?

Yes, receiving Social Security benefits without enrolling in Medicare is possible. You are typically eligible for Medicare when you turn 65, while you can claim Social Security benefits at 62. This time gap means you may receive Social Security without Medicare for several years.

Is It Mandatory to Sign Up for Medicare After Age 65?

Medicare Calendar 65 Years Old Elgible for Coverage Sign Up - Do You Automatically Get Medicare with Social Security?

No, enrolling in Medicare is not strictly mandatory after you turn 65. However, it is a decision to approach with ample information and careful consideration. While applying for Medicare coverage is straightforward—you can do so in person at your local Social Security office, online, or over the phone—there are potential financial ramifications if you delay enrollment without qualifying reasons.

If you enroll in Medicare as soon as you’re eligible, you avoid potential waiting periods or financial penalties. For those who continue to work past age 65 and have health insurance through an employer with 20 or more employees, there’s an option to delay Medicare enrollment. 

In these cases, the employer’s group health plan often serves as the primary insurance, potentially allowing you to postpone Medicare enrollment without facing late penalties. However, always discuss with your HR or benefits administrator to ensure you’re adequately covered and understand any implications of delaying Medicare.

What Happens If You Do Not Sign Up For Medicare?

While the decision to enroll in Medicare is ultimately up to you, it’s essential to understand the consequences of not enrolling:

Full Medical Costs: Without Medicare or alternative private health insurance, you’ll be responsible for the full cost of your care. These expenses can quickly become financially crippling, especially if unexpected health issues arise.

Potential Delays: Delaying Medicare enrollment might mean facing waiting periods when you eventually decide to sign up. This delay could leave gaps in your healthcare coverage when you might need it most.

Late Enrollment Penalties: Deferring Medicare registration can come with a cost. Specifically for Part B, your premium may increase by 10% for each full 12-month period that you could have been enrolled in but weren’t. This added cost isn’t a one-time fee—it stays with your premium for as long as you have Part B. Therefore, weighing the benefits and drawbacks of delaying enrollment is essential, especially if you don’t have a qualifying reason like employer coverage.

Navigating Medicare and Social Security Benefits With The Medicare Family 

Navigating the intricacies of Medicare and Social Security can be challenging. It’s vital to understand when and how you’ll be enrolled, the potential financial implications of delaying enrollment, and the benefits you’re entitled to. Staying informed ensures that you can make the best decisions for your health and financial well-being. 

Understanding Medicare and Social Security can be tricky, but you don’t have to figure it out on your own. At The Medicare Family, our team is dedicated to guiding you through every step, ensuring you make well-informed choices tailored to your needs. Schedule an appointment today, and let’s simplify this journey together, giving you both clarity and confidence.

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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