Answer:

Medicare isn’t mandatory, although most people will choose to sign up during their initial enrollment period due to late enrollment penalties.

Consider the following factors:

  • Medicare Part A, B, and D are all subject to a late enrollment penalty. The penalty amount is added to your premium for missing your initial sign up window and don’t otherwise have creditable coverage.
  • Premium-free Part A being available to most citizens when they turn 65 based on the Medicare taxes they have paid while working. Given Part A is typically free to have, it doesn’t make sense to reject it for most people.
  • Premium assistance is available based on income, so putting off Medicare due to cost can often not make sense (especially given late enrollment penalties).

In short, if you have other creditable coverage, such as coverage via an employer, then choosing to get Medicare when you turn 65 can make sense. Otherwise, in most cases, people will want to get Medicare when they turn 65 to avoid late enrollment penalties down the road. That said, no part of Medicare is mandatory.

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