While signing up for Medicare is not required, signing up late can result in an ongoing late enrollment penalty. Most people will qualify for Medicare when they turn 65 and will want to sign up for Original Medicare Parts A and B then.
People who have worked and paid Medicare taxes long enough will qualify for Part A (hospital insurance) for free, so there is very little downside to not signing up for them. Meanwhile, those who don’t automatically qualify can sign up for a premium when they turn 65, for them they may incur a late enrollment penalty and therefore will likely want to sign up as well.
Part B (medical insurance) has a premium and is subject to a late enrollment penalty, so most will sign up for that too unless they are going to defer without penalty due to having other creditable coverage (such as employer coverage in some cases).
Most people can enroll in Medicare up to 3 months before your 65th birthday, during the month of your 65th, and for up to 3 months after. Meanwhile, others will be automatically enrolled or can enroll before they turn 65 depending on specific circumstances.
Lastly, many will also choose optional additional Medicare types including Part C (Medicare Advantage), Part D (Drug Coverage), and Medigap. Although these coverage types have their own late enrollment rules as well.
In short, you aren’t required to sign up for Medicare, but in most cases, people who eligible are automatically enrolled or are incentivized to sign up unless they have other creditable coverage options.
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