Can you decline Medicare coverage? Delaying Enrollment Could Result in a Permanent Penalty. As described above, you can't reject premium-free Medicare Part A (hospital coverage) without also giving up your Social Security benefits. ... The other parts of Medicare, however, do involve premiums that you have to pay in order to keep the coverage in force.Jul 12, 2019 What happens if you don't sign up for Medicare? If you don't sign up for Medicare during your initial enrollment window, you'll face a 10% increase in your Part B premiums for every year-long period you're eligible for coverage but don't enroll. Therefore, it generally pays to sign up for Medicare at 65 -- unless you happen to qualify for one major exception.Apr 5, 2018 What is the penalty if you don't sign up for Medicare at 65? Medicare Part A late-enrollment penalty If you don't enroll when you're first eligible for Medicare, you can be subject to a late-enrollment penalty, which is added to the Medicare Part A premium. The penalty is 10% of your monthly premium, and it applies regardless of the length of the delay.