updated 10/8/2008 6:58:14 PM ET 2008-10-08T22:58:14

Three men who say they have adequate health coverage and enough money to pay for their health care needs want to opt out of hospital coverage under Medicare. Federal rules say they cannot collect Social Security benefits if they do that.

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Their goal is to save taxpayer money by voluntarily forgoing Medicare. Their challenge to the policy is coming in lawsuit expected to be filed Thursday in federal court.

It would not cost them anything to participate in Medicare Part A, which covers care delivered at the hospital. Medicare participants pay a deductible of $1,024 if admitted to the hospital.

There is no monthly charge, so it would seem prudent for the vast majority of older people to maintain enrollment in Medicare Part A. But people who want out say they have a good relationship with their doctors and can pay for their care. They do not want to risk that relationship with participation in an entitlement program that many believe needs much belt-tightening to serve future generations.

“They just believe they get better care, they have more privacy if they manage it themselves,” said Kent Masterson Brown, a Kentucky lawyer handling the case.

Other important aspects of Medicare, such as the programs covering physician services and prescription drug coverage, do require a monthly premium from most participants. But those programs are voluntary. People can opt out without worrying about what it means for their Social Security benefits.

In 1993 and 2002, the Social Security Administration issued rules that, in effect, said retirees would lose their Social Security payments if they opted out of Medicare Part A. The plaintiffs in the case intend to make the case that the rules were put into place without being published beforehand in the Federal Register and without benefit of public comment, which Brown said violated the Administrative Procedures Act.

The defendants in the case would be the heads of the Health and Human Services Department and the Social Security Administration.

Officials said they could not respond Wednesday to the rationale for barring people from Social Security if they opted out of Medicare Part A, but they did confirm that participation is a requirement to get a Social Security check.

“The law is clear here,” said Jeff Nelligan, spokesman for the Centers for Medicare and Medicaid Services. “If an individual receives a Social Security check, that person must accept the Part A benefit.”

The men challenging the rule are Brian Hall of Catlett, Va., Lewis Randall of Freeland, Wash., and Norman Rogers of Miami.

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