Medicare Part A is the part that covers hospital treatment. People qualify once they reach 65 years of age. Those with end stage renal disease or Lou Gehrig’s disease may be eligible before this age.
People become eligible to sign up for Medicare 3 months before the month of their 65th birthday. They can also apply during the 3 months after their birth month.
In this article, we explain the eligibility criteria for Medicare Part A. We also look at whether spouses are eligible based on their partner’s qualification for Medicare and the reasons why a person might not qualify for Part A.
Most people qualify for Medicare Part A when they reach 65 years of age.
A person has a 7-month enrollment window. This window includes the 3 months before their birthday, the whole month in which the birthday takes place, and the 3 months afterward.
Applying outside this period means that a person will have to pay a higher premium.
If a person already receives retirement benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB), these organizations will automatically enroll a person in Medicare Part A.
Some people can qualify earlier for Medicare Part A if any of the following apply:
Disability benefits: If a person has received disability benefits from the SSA or RRB for 24 months, they may qualify to receive premium-free Medicare Part A benefits.
For a person to qualify for Medicare under disability criteria, a doctor must certify that they are living with a disability.
The eligible disabilities may vary and can include both physical and mental conditions.
End stage renal disease: If a person has end stage renal disease and is on dialysis or has had a kidney transplant, they may qualify for premium-free Part A.
They will not typically have to wait 24 months for coverage, as is the case with people who have some other disability requirements.
Amyotrophic lateral sclerosis (ALS): Those with ALS, or Lou Gehrig’s disease, qualify for Medicare Part A. They often do not have to wait 24 months for eligibility.
A person will usually automatically start receiving Medicare Part A in the same month that they receive their disability benefits from the SSA or RRB.
If a person has a question regarding their eligibility for Medicare Part A or other aspects of Medicare, they should contact the SSA at 1-800-772-1213 (TTY: 1-800-325-0778).
A person who is 65 or older may qualify for Medicare Part A benefits if their spouse has paid Medicare taxes for 40 quarters of employment. This would entitle them to a premium-free Part A plan.
If a person is younger than their spouse and has not yet reached 65 years of age, they cannot qualify for Medicare earlier based on their spouse’s eligibility, unless they have a qualifying disability.
For example, if a person is 62 and their spouse is 65, they cannot obtain Part A benefits until reaching 65 themselves.
A person must be 65 or older to qualify for Medicare Part A. Unless they meet other requirements, such as a qualifying disability, they cannot get Medicare Part A benefits before this age.
Some people may be 65 but ineligible for premium-free Medicare Part A. For instance, a person who did not work for 40 quarters and pay Medicare taxes would not be eligible.
If a person has paid Medicare taxes for 30–39 quarters, they can pay a reduced premium for Medicare Part A, at $259 per month. If a person has paid the taxes for fewer than 30 quarters, they may need to pay a $471 monthly premium.
Even without a premium, Medicare Part A is not a completely free insurance plan. Out-of-pocket costs still apply.
Medicare Part A covers hospital services and skilled nursing facility care. Examples of services that Medicare Part A may cover include:
- care when a person stays at a hospital for at least 2 midnights
- home healthcare (must include medical care, not just general care, such as help with feeding or bathing)
- hospice care
- skilled nursing facility care
Medicare Part A does not cover long-term or custodial care. It only covers medical care that focuses on helping a patient improve their overall condition.
Once a person has signed up for Medicare Part A, their coverage will usually begin in the month that they turn 65. However, this may not always be the case, depending on when a person signed up for Medicare. For example, a person might not sign up until after their birth month.
A person may have to pay penalties for Medicare Part A if they enroll outside the open enrollment window.
Medicare adds 10% to the premium for double the number of years for which a person did not sign up for Medicare Part A while eligible.
For example, if a person waits 3 years after reaching the age of 65 to apply for Medicare Part A, their premium increase will last for 6 years.
It is best to apply during the initial open enrollment window, as this makes Medicare plans more cost effective.
Medicare Part A is part of a state-funded health insurance plan. People are eligible for this part of Medicare if they have reached 65 years of age or have a qualifying disability.
Depending on the number of quarters over which a person has paid Medicare taxes, they or a spouse of qualifying age may be eligible to receive Part A coverage without paying a premium.
People should enroll within a window that spans a 7-month period with the month of their 65th birthday at the center. Registering outside this window may lead to a higher premium.