Medicare Part A Eligibility
Key Takeaways
- Eligibility for Medicare Part A, commonly referred to as hospital insurance, typically begins at age 65 for U.S. citizens.
- If you are eligible for Part A, you don’t have to pay a monthly premium if you have paid Medicare taxes through an employer for 10 years or more.
- If you don’t have a premium, you can enroll in Part A at any time, but generally there’s no reason why you would delay beyond age 65.
- If you do owe a premium, your chances to enroll after 65 could be limited and you could face a late enrollment penalty.
Medicare Part A eligibility is a big deal.
Medicare Part A provides peace of mind for millions of older Americans, covering a significant portion of their bills if circumstances land them in the hospital. In addition, the large majority of people who qualify for Medicare Part A don’t have to pay a monthly premium.
You may be asking yourself, “Am I eligible for Medicare Part A? And if I am eligible, how do I enroll?”
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What Exactly Is Medicare Part A?
Part A of the federal government’s Medicare program is commonly referred to as hospital insurance.
In a nutshell, Part A is health insurance that covers inpatient hospital stays. Inpatient stays generally are defined by Medicare as medically necessary stays crossing over two or more midnights in a hospital or similar facility. Usually, the hospital-related expenses for your qualifying stay are 100 percent covered by Medicare Part A for stays of 60 days or less — after you pay the benefit period deductible ($1,632 in 2024).
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Medicare Part A Eligibility and Initial Enrollment
For most people, the trigger for Medicare Part A eligibility is simple: When you turn 65 years old, you become eligible.
But being eligible and being enrolled are two different things.
If you have been receiving Social Security benefits (or Railroad Retirement Board benefits) for at least four months leading up to your 65th birthday, you will be automatically enrolled in Medicare Part A (as well as Medicare Part B). It’s becoming less common for people to be automatically enrolled as legislation has pushed the age for receiving full Social Security benefits beyond 65.
So, if you want to be enrolled in Medicare Part A at age 65 — which makes financial sense for the large majority of people — then you may have to take a little initiative. You can enroll in Medicare Part A by:
- Applying online with the Social Security Administration.
- Calling 1-800-772-1213 to apply (TTY: 1-800-325-0778).
- Visiting a local Social Security office.
When exactly should I enroll in Part A?
Your first chance to enroll in Part A and Part B (commonly called medical insurance) of Original Medicare is a seven-month period surrounding your 65th birthday. This is called your Initial Enrollment Period.
Your Initial Enrollment Period includes the three months before you turn 65, the month you turn 65 and the three months after you turn 65 (or, if your birthday falls on the first day of the month, it’s the four months before your birthday, the month you turn 65 and the two months after).
While that’s your first chance to enroll, here’s another perk specific to Part A: Most people who don’t enroll before turning 65 can do so at any time and can receive up to six months of retroactive coverage.
So:
- If you enroll in Part A in the months leading up to your birthday, coverage will begin the first day of your birthday month (or, if your birthday is on the first of the month, coverage begins the first day of the month before your birthday).
- If you enroll in Part A within six months of your 65th birthday, your coverage is retroactive to the first day of your birthday month (or, if your birthday is on the first of the month, coverage begins the first day of the month before your birthday).
- If you enroll in Part A later than that, your coverage is retroactive to six months before you signed up.
Is There a Premium for Medicare Part A?
Who is eligible for free Medicare Part A ?
Almost everyone!
(Although it should be noted that even for those who don’t pay a monthly premium, Part A can’t truly be called “free” because of the portion of costs that you incur when making a claim).
According to the Centers for Medicare & Medicaid Services, about 99% of people qualify for Part A coverage without a monthly premium. That’s because the Medicare program is fueled by Medicare taxes taken out of paychecks. If you have paid those taxes for at least 40 quarters (10 years) over your lifetime, then you qualify for Part A without a monthly premium.
If you haven’t worked that long, you likely owe a monthly premium (and you must also enroll in Part B if you want Part A). There is, however, another way you could qualify for Part A without a monthly premium…
Is My Spouse Eligible for Medicare Part A?
Medicare eligibility and enrollment is an individual thing, so the rules regarding Medicare Part A spouse eligibility are the same for both people. However, it is possible for a spouse to help you qualify for Part A without a monthly premium.
Here’s how it works: If you don’t qualify for a no-cost Part A premium, you can use your spouse’s work history to qualify. If you haven’t paid Medicare taxes for 10 years but your spouse (or former spouse) has, you are eligible for Part A without a premium.
One caveat: Your spouse must be at least 62 years old. But remember, Medicare Part A eligibility is an individual thing, so your spouse still won’t qualify for Part A until age 65.
Part A General Enrollment
If you have Medicare Part A eligibility but don’t enroll within six months of your 65th birthday, there are options for enrolling late. The options vary based on whether you’re among the majority of people who don’t have to pay a Part A monthly premium, or if you’re in the minority that do.
I Don’t Have To Pay a Part A Monthly Premium
If you’re in this camp, then you can sign up for Part A at any time.
- If you sign up during your Initial Enrollment Period or within six months after you turn 65, you will be covered by Part A beginning on the first day of the month you turn 65.
- If you sign up later than that, your coverage will be retroactive to six months before you enrolled.
I Do Have To Pay a Part A Monthly Premium
If this includes you, it’s a little more complicated because people who owe a Part A premium must also enroll in Part B. Once your Initial Enrollment Period ends, you have limited times of the year when you’re allowed to enroll in Part B (and thus Part A).
- You can sign up during the General Enrollment Period that runs from January 1 to March 31 each year.
- You can sign up during a Special Enrollment Period that you’re granted, for example, because you lost group health coverage from an employer.
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Open Enrollment for Part A
Your eligibility for Part A isn’t limited to when you first sign up for Medicare. If you switch from Original Medicare to a Medicare Advantage plan, you may want to go back to Original Medicare at some point. Medicare’s Open Enrollment Period (sometimes called the Annual Enrollment Period) is one of your chances to do so.
Held each year from October 15 to December 7, this enrollment window is often used by Medicare Advantage beneficiaries to change their Part C plans for the upcoming calendar year. But if you have Part C and want to go back to Original Medicare, you’re eligible to enroll in Medicare Parts A and B again, and you can also join a Part D plan. This coverage will go into effect January 1 of the following year.
Medicare Advantage Open Enrollment
This enrollment window gives Medicare Advantage beneficiaries another chance to make changes to their coverage. Medicare Advantage beneficiaries can switch to another Part C plan or drop their Medicare Advantage plan and re-enroll in Original Medicare from January 1 to March 31 (the same dates as the General Enrollment Period). This can be especially helpful if you switched to a Medicare Advantage plan during the fall open enrollment but later notice your new plan’s coverage or network doesn’t meet you needs.
How much is the Part A monthly premium?
- $278 if you’ve paid Medicare taxes for 30-39 quarters.
- $505 if you’ve paid Medicare taxes for less than 30 quarters.
How much is the Part A late enrollment penalty?
- For every year you didn’t enroll, you will have a 10% penalty added to your Part A premium for two years.
- So, if you delayed enrollment for three years for example, you’ll have a 30% penalty added to your Part A premium for six years.
Is it possible to be eligible for Part A before age 65?
- If you have collected Social Security disability benefits for 24 months, you are eligible. If you are approved for Social Security disability because you’ve been diagnosed with Amyotrophic Lateral Sclerosis (also known as Lou Gehrig’s disease), you can enroll in Part A the first month you are approved for Social Security disability.
- If you have end-stage renal disease, you can enroll in Part A on the first day of your fourth month of dialysis.
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Sources
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA. gov.
- Ready to sign up for Part A & Part B. Medicare.gov.
- Medicare Costs. Medicare.gov.
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