Medicare is mandatory in retirement.

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With changes to Social Security’s Program Operations Manual system (POMS) Medicare is mandatory. This impacts those who are retired, 65 years-old or older and who are no longer covered by creditable health coverage through an employer or spouse’s employer.

In order to receive Social Security they must accept Medicare.

In 2005 an appellant known as J.J.K. brought a challenge to this ruling. J.J.K. “did not wish to enroll in Medicare HI benefits when he applied for Social Security benefits”. He also wanted “only to receive the retirement benefits but was not permitted to opt out of HI”.

The ruling by the Department of Health Human Services (DHS) in 2008 on J.J.K.’s case was that in order to “withdraw from the HI program (Medicare), an individual must submit written request for withdrawal and must refund any Social Security benefits paid on his/her behalf.”

DHS’ ruling was based on the conclusion that “retirement benefits were “awarded along with Medicare Part A”. Further, that he “cannot waive the entitlement to Medicare Part A” and be paid only the retirement benefits because the “Part A entitlement is tied to monthly benefits.”

In 2009 this rule was challenged again by Brian Hall. Mr. Hall sued for the right to receive only his Social Security benefit while not enrolling into Medicare. This case is known as “Hall vs. Sebelius”.

Federal Judge Rosemary Collyer, in 2011, dismissed the case and ruled that by not enrolling would be “contrary to congressional intent, which was to provide mandatory benefits under Medicare Part A for those receiving Social Security Retirement benefits”.

This ruling was then appealed further to the United State Court of Appeals, No. 11-5076, which concluded that “An individual is statutorily entitled to Medicare Part A upon becoming entitled to monthly Social Security retirement benefits (SSRB).”

In the decision it was further added that “Individuals entitled to monthly benefits which confer eligibility for HI may not waive HI entitlement. The only way to avoid HI entitlement is through withdrawal of the monthly benefit application. Withdrawal requires repayment of all [SSRB] and HI benefit payments made”.

Per federal regulation to receive your Social Security benefit, you must accept Medicare.

Your greatest asset is your health, the time to plan for it is today.

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