If a person has never worked, they may qualify to get premium-free Medicare Part A. If a person does not qualify, they may get Part A by paying the premium.
In general, most people don’t pay any monthly premium for Medicare Part A, because the taxes a person paid through work contribute to a person’s eligibility for coverage. However, there is a minimum contribution amount equal to at least 40 quarters throughout a person’s working years.
In this article, we discuss how a person can get Medicare Part A without paying the premium, and how they may qualify for the coverage. We then describe how to get Part A while paying the premium, plus enrollment periods and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A person who has not worked may qualify for premium-free Medicare in one of two ways: a person’s spouse has enough work history to qualify, or a person has certain disabilities or medical conditions.
A married person may qualify for Medicare Part A and not have to pay the premium, because their eligibility is based on a spouse’s work history.
In general, a person needs a minimum of 40 calendar quarters of work to be eligible for Part A. However, if they do not meet that requirement, their spouse’s work record may allow them to get coverage without paying the premium.
If a person’s spouse meets the minimum requirement, this means the person with insufficient quarters of work may be eligible when they turn 65 years of age.
In addition, a non-working spouse may get Medicare Part A without having to pay a premium for the following reasons:
- The person is married and their spouse is eligible for Social Security benefits. They must be married for a minimum of 12 months before applying.
- The person is divorced from their spouse, and the former spouse is eligible for Social Security benefits. They must have been married for a minimum of 10 years and the non-working spouse must now be single.
- The person is widowed but was married for a minimum of nine months before the spouse died. The person must now be single.
Disabilities or medical conditions
If a person has certain disabilities or medical conditions, they may be able to get premium-free Medicare Part A before they are aged 65 or older.
For example, a person with end stage renal disease (ESRD) may be eligible for premium-free Part A if they also meet one of the following conditions:
- they must also be on dialysis or have received a kidney transplant
- they qualify for Railroad Retirement Board benefits
- they qualify for Social Security retirement benefits
- they have a parent or spouse who is eligible for social security retirement benefits
A person with Lou Gehrig’s disease is eligible for Part A coverage in the first month in which they get disability benefits.
A person can use this tool to check if they are eligible and the cost of premiums.
If a person is not eligible for premium-free Part A, they may be able to buy Part A.
However, they will need to pay the monthly premium, which ranges from $252 to $458. The premium amount depends on how many quarters a person has paid taxes.
If a person buys Part A, they may also need to get Part B, which is medical insurance. The basic premium for Part B in 2020 is $144.60.
If a person is getting Social Security benefits, they will be automatically enrolled in original Medicare, Part A and Part B, when they turn 65 years old.
If a person needs to enroll, there are different Medicare enrollment periods.
Initial enrollment period
Medicare has an Initial Enrollment Period (IEP) of 7 months. During that time, a person can enroll for Medicare Part A and Part B:
- during the 3 months before the month a person turns 65
- during the month a person turns 65 (birthday month)
- before the end of 3 months after the month in which a person turns 65
Late enrollment period
If a person does not enroll in original Medicare during the IEP, they can do so during the General Enrollment Period, which is from January 1 to March 31 each year. However, they may have to pay penalties.
If a person chooses to buy Part A, the premium can vary from $252 to $458 a month, depending on the amount of taxes they have paid.
- The standard Part A premium in 2020 is $458 per month. A person would pay this amount if they paid Medicare taxes for less than 30 quarters.
- The standard Part A premium for 2020 is $252 per month if a person has paid Medicare taxes for 30 to 39 calendar quarters.
- There may also be deductibles and coinsurance.
If a person chooses to buy Part A, they must also have Part B, which covers medically necessary and preventive services. The Part B monthly premium can vary depending on income, and a person must also pay deductibles and coinsurance.
What is a calendar quarter?
The Social Security Administration (SSA) divides a calendar year into 4 quarters. A calendar quarter refers to a 3-month period, which ends at one of the following calendar dates:
- March 31
- June 30
- September 30
- December 31
The SSA keeps track of each 3-month quarter a person works and pays their social security and Medicare taxes. Each quarter contributes to a person’s eligibility for Medicare Part A.
While most people don’t pay a monthly premium for Medicare Part A, a person who has never worked may be eligible, in certain circumstances, to get premium-free Part A. However, they may have to buy Part A and Part B.
A person should check to make sure they aware of premiums, deductibles, and coinsurance, as well as deadlines for enrollment.