What are the qualifications to get Medicare Part A Hospital at no cost?

 

Are there Alternatives to paying  $471/month? Medicare.Gov

To be eligible for premium-free Part A, Hospital – an individual must be entitled to receive Medicare based on their own earnings or those of a spouse, parent, or child.

To receive premium-free Part A, the worker must have a specified number of quarters of coverage (QCs) [40] and file an application for Social Security or Railroad Retirement Board (RRB) benefits.

The exact number of QCs (quarters) required is dependent on whether the person is filing for Part A on the basis of age, disability, or End Stage Renal Disease (ESRD). QCs are earned through payment of payroll taxes under the Federal Insurance Contributions Act Wikipedia (FICA) during the person’s working years.

Most individuals pay the full FICA tax so the QCs they earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A. Medicare & You Handbook – and Enrolling in A & B See link in side panel *

One spouse did not work and pay into Medicare for the 40 quarters.

Can they apply under their spouses entitlement?

 

If you’re at least 62 and have worked at least 10 years in Medicare-covered employment, your spouse can get Part A and Part B at 65.

If you’ve worked at least 10 years in Medicare-covered employment but aren’t yet 62 when your spouse turns 65, they won’t be eligible for premium-free Part A until your 62nd birthday. In this case, your spouse should still apply for Part B at 65, so they can avoid paying a higher Part B premium.

However, if you’re still working and your spouse is covered under your group health plan, they could delay their Part B enrollment without paying higher premiums. Publication 11036   

Web Visitor Q  & A

What about qualifying on my spouses work history?

How can I get Medicare  if I don’t qualify for FREE Part A Medicare?

 

If you  have to  buy Part A, you’ll pay the Part A premium aka Premium Part A which runs up to $458 each month Medicare.Gov *

How to earn Social Security – Medicare Credits Publication # 10072 *

Survivor Benefits # 10084 *

Watch out for penalties if you don’t enroll when you are supposed to.

If you are lawfully present, over age 65, but not eligible for Medicare – You qualify for Obamacare!  Including Subsidies

Get FREE Quotes. *  Subsidies.

How long must one live in the USA to be able to buy into Medicare?

 

An individual must be a U.S. resident and either a citizen, or an alien lawfully admitted for permanent residency who has resided in the U.S. continuously for at least 5 years as of the time the application is filed.  persons desiring Premium-Part A can only file for coverage during a prescribed enrollment period (see the discussion under Medicare Part B) and must also enroll or already be enrolled in Part B.  CMS.Gov

Medicare Eligibility Calculator

Don’t have 5 years?  Check out the Bridge Plan or ACA/Obamacare 

 

Part A late enrollment penalty

 

If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up.

Example

If you were eligible for Part A and have to pay a premium  for 2 years but didn't sign up, you'll have to pay the higher premium for 4 years. Usually, you don't have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a special enrollment period.

 

 
I have employer Coverage
 

Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you're covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:

  • You or your spouse (or family member if you're disabled) is working.
  • You're covered by a group health plan through the employer or union based on that work.

You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):

  • The month after the employment ends
  • The month after group health plan insurance based on current employment ends

Usually, you don't pay a late enrollment penalty if you sign up during a SEP.

 

How to apply for Part B during your special enrollment period # 10012

Fact Sheet
Deciding Whether to Enroll in Medicare Part A and Part B  When You Turn 65
  15 pages

Note
 

COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn't apply to people who are eligible for Medicare based on having End-Stage Renal Disease (ESRD).

 

Note
 

If you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on your or your spouse’s current employment, you may be eligible for an SEP. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).

 

You may also qualify for a Special Enrollment Period for Part A and Part B if you're a volunteer, serving in a foreign country.
 

Get an estimate of your Medicare eligibility date.

Learn how to sign up for Medicare if you have coverage through the Health Insurance Marketplace.Copied from Medicare.Gov

Links & Resources

Medicare & You Print & Video  150 pages Excellent Introduction

Get Subsidies on Covered CA?

medicare.gov/cost/ Part B – Deductibles – Co-Pays

Medicare  ONLINE Enrollment Instructions & Links

You cannot buy additional coverage through #Covered California
if you have premium-free Medicare Part A Hospital

 

Medicare complies with Health Care Reform, so you do NOT need to get a an Individual policy or a subsidized one from Covered CA.  It fact, it's illegal for anyone to sell you a policy!  Kaiser Health News * Covered CA Medicare Fact Sheet * Medicare.Gov Medicare & Market Place #11694  * CMS.Gov FAQ Medicare & Marketplace * HealthCare.Gov when - how to change from Covered CA to Medicare  * Social Security §1882  * Health Care.Gov

NOTE: This information also applies to people younger than 65 whose benefits begin the first month they receive disability benefits because they have Amyotrophic Lateral Sclerosis (ALS), better known as Lou Gehrig’s Disease, and to people younger than 65 who have Medicare because of a disability and are receiving SSDI Social Security Disability Insurance.

 

There are a lot of ands, if or buts in this complex issue.  Please refer to the source material below.  There are some exceptions, but they are very complex.  Don't even think of getting a 1/2 correct answer over the phone. If you have to pay for Part A Hospital, then are options, like subsided Covered CA Plans. Email us [email protected] or ask a question below.

Video about Covered CA – if no Premium Free Part A – jump to 2:30  Medicare & the Marketplace (Covered CA

Links & Resources 

Sec. 1882. [42 U.S.C. 1395ss]

(3)(A)

(i) It is unlawful for a person to sell or issue to an individual entitled [no premium] to benefits under part A or enrolled under part B of this title (including an individual electing a Medicare+Choice plan [MAPD] under section 1851)—

(I) a health insurance policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under this title or title XIX,

(II) in the case of an individual not electing a Medicare+Choice plan, [aka MAPD Medicare Advantage] a medicare supplemental policy with knowledge that the individual is entitled to benefits under another medicare supplemental policy or in the case of an individual electing a Medicare+Choice plan, a medicare supplemental policy with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled under the Medicare+Choice plan or under another medicare supplemental policy, or

(III) a health insurance policy (other than a medicare supplemental policy) with knowledge that the policy duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of State or Federal law.

(ii) Whoever violates clause (i) shall be fined under title 18, United States Code, or imprisoned not more than 5 years, or both, and, in addition to or in lieu of such a criminal penalty, is subject to a civil money penalty of not to exceed $25,000 (or $15,000 in the case of a person other than the issuer of the policy) for each such prohibited act. Sec. 1882. [42 U.S.C. 1395ss] 

 

Our webpages that touch on this Issue:

18 comments on “Part A Hospital rules for zero premium

  1. FAQ from Updated Page

    1. Page K says:
      I am 65 with insufficient credits for Social Security benefits. My younger husband is 60 and both covered under his group health insurance, including a “credible” Part D.
      #1) My understanding from various call and office visits to Social Security is that I do not sign up for Social Security until my husband applies at 65.
      #2) Since I am fully covered by his group health insurance, I do not apply for Medicare until he applies for his Social Security at which time I would apply for spousal benefits?
      Is there something I should be doing before I turn 65 to avoid penalties later?
      Thank you.
      Reply
      • Steve shorr says:
        Thanks for your question. It prompted us to spend several hours updating our website to be more helpful to the public. How many employees are at your husbands work? More or less than 20? This new section of our website appears to be the most relevant to answer your question.
        Reply
    2. Ananth K says:
      hi Steve,
      My father and mother have had Covered CA Silver 94 PPO plan, with APTC since ACA went into effect. Their income is below FPL but through two years of consecutive appeals hearing, the Judge had ordered Covered CA that they are eligible for APTC since they are not eligible for non-MAGI Medi-Cal (since both my dad and mom are above 65, and have assets more than Medi-Cal limits, and they cannot spend down). Both my dad and mom have been legal permanent residents (green card) at the time of the appeals in 2016 and in 2015. They are eligible for Medicare but are not eligible for premium-free Medicare, and Covered CA did send them a letter stating that people who are not eligible for premium-free Medicare and who dont enroll in Medicare could be eligible for APTC. Just like last two years, again for 2017, Covered CA has told them that we are not eligible for APTC for 2017 coverage. My dad became a US citizen late 2016. But they continue to be ineligible for Medi-Cal, or premium-free Medicare. And without APTC, they cannot afford to get an affordable minimum qualified health plan. They have filed for an appeal, but if you can point us to any sections of the ACA, or Federal Code of Regulations or California regulations, or special rules/clarifications, or IRS notes that we can represent to the judge during our hearing, it would be really helpful. It is strange that while they would be eligible for APTC as non-citizen aliens (as decided by the Judge last 2 years), their becoming a citizen makes it worse for them.
      Reply
      • This is a rather complex question. We will answer on this new page.
        Reply
    3. Jackie says:
      Steve, 

      I have a few questions that I have numbered below for convenience.

      Regarding the sign up on the Social Security site, I understood from your email last week that I should sign up for:

      1. Medicare parts A and B.

      2. But should I also sign up for part D?

      3. What about Medigap?

      4. When do I sign up for part C (Advantage)?

      5. Once I sign up for Medicare can I start my coverage with the Blue Shield 65 Plus (HMO) plan effective April 1, 2016? If not, when will that coverage start?

      6. Once that coverage begins, do I pay for it until Bruce turns 62 in October?

      7. Also, have you heard from Blue Shield yet?

      Please try to answer today if you can so that I can try to sign up today.

      Thanks.

      Reply
      • 1 That’s correct 

        2 No, as you were getting the Blue Shield Medicare Advantage Plan. It includes Part D, Rx. Use the menu above to learn more about the Blue Shield and other plans.

        3 Medicare Advantage is pretty comprehensive and highly regulated. It’s my understanding an agent can go to jail if they sell you a Medi Gap plan in addition to a Medicare Advantage plan, as you don’t need the additional coverage.

        4 As soon as you get Part B, that should give you a new enrollment period into Medicare Advantage – Part C. OOPS!!! One has to check every rule, I don’t see that in Publication 11219 Understanding Medicare C & D Enrollment periods. It’s if you get Part B during the general enrollment period then you get a Medicare Advantage enrollment period. So, if you get your Part A & B NOW, then you can apply by the end of March for a April 1 start date. This MUST be done by the 31st as your 65th birthday was in December. We have your Blue Shield application, just give us your Medicare #.

        5 Yes. Sign up TODAY and get us the number. At least some PROOF that you’ve signed up and will be effective in April!

        6 The Blue Shield Medicare Advantage plan has no premium, other than the optional dental. Use the menu above to get the details and disclosures.

        You will always pay for Part B Medicare – Doctor Visits.

        It’s my understanding that once your husband turns 62 then you won’t have to pay the Part A premium of $426/month. Everything I have on buying Part A is on the page above or in the links to Medicare, Social Security and CMS websites.7 I just reemailed them and they agreed that you can pay for Part A or wait till your husband turns 62. If there are Part B late enrollment penalties, Blue Shield doesn’t do that. Social Security assesses them. The late enrollment penalty calculator also shows Part A premium and when one is eligible.

  2. My 82-year-old mom came to live in the United States this year and got her green card in July 2013.
    She is not eligible for Medicare since she has never worked/paid taxes in this country.

    How much will it cost to insure her?

    A. Most immigrants who are “lawfully present,” including people with permanent resident status (also known as green card holders), can buy coverage on Covered CA. No extra charge to use an agent. Just like citizens, they are also eligible for premium tax credits and cost-sharing assistance if they meet the income requirements. (In fact, most legal immigrants must have coverage by 2014, unless they qualify for an exemption.)

    As a green card holder, your mother will be eligible for Covered CA , but will need to live here for five years to qualify for Medi-Cal. Since she is not eligible for Medicare, however, she can apply for a premium tax credit, said Lynn Quincy, a senior policy analyst at Consumers Union. New York Times

    • I have less than 40 Social Security quarters and I will have to pay a premium for Part A, Part B and Part D.
      Can I buy a health plan from Covered California?

      We think people who will have to pay a premium for Part A because they are not entitled to premium-free Medicare Part A can buy a Qualified Health Plan if they are not already enrolled in Medicare. … If you are eligible for a tax credit through Covered California, remember to take into account any premium assistance or cost-sharing subsidy that might reduce your costs for a QHP. CA Health Advocates * Covered CA Fact Sheet Page 2 Paragraph 5 * https://www.coveredca.com/PDFs/Medicare-CC-Fact-Sheet-English.pdf#page=2

  3. I’m 65 now and have worked and paid taxes into Medicare for 50 years. I’m not lawfully present. Can I still enroll and not risk getting deported?

    • Here’s our webpage on Lawful Presence for ACA/Obamacare….

      I’m not an immigration attorney. I don’t see how though that taking Medicare, that you’ve paid into would be considered a Public Charge.

      For purposes of determining inadmissibility, “public charge” means an individual who is likely to become primarily dependent on the government for subsistence, as demonstrated by either the receipt of public cash assistance for income maintenance or institutionalization for long-term care at government expense. https://www.uscis.gov/greencard/public-charge

      What happens to benefit payment if a beneficiary is in the U.S. but is not a U.S. citizen or lawfully present alien?
      • Payment to a claimant entitled to monthly title II

      ***Disabilty SSA.Gov ***** Disability Benefits.org

      and title XVIII

      ***Medicare A & B Very Technical SSA.gov ******** Medicare & You

      benefits who meets all factors of entitlement will be suspended for any month that he/she is in the U.S. but has not established his/her U.S. citizenship/lawful presence for a full calendar month.

      • Payment of monthly title II and title XVIII benefits for periods of retroactive entitlement that fall prior to 12/1/96 will be suspended if the title II and title XVIII application was filed 12/1/96 or later.

      • Payments to a title II and title XVIII beneficiary suspended retroactively for failing to establish U.S. citizenship or lawful presence are overpayments subject to the rules of due process. Action to recover the overpaid amount will be taken in accordance with normal recovery procedures. The overpaid person must be given notice of the overpayment, the proposed recovery action, and the right to reconsideration, waiver, personal conference, or a different rate of adjustment (or refund by installment). (See GN 02201.001 for an explanation of processing overpayments.)

      • Section 5561 of the Balanced Budget Act (BBA) prohibits payment for Medicare services rendered to an alien who is not lawfully present in the U.S. It is important to differentiate between the U.S. lawful presence requirement prohibiting “payment” for Medicare services rendered to an alien who is not lawfully present in the U.S. and policy in HI 00801.191D.2. indicating that there is no U.S. residency requirement for determining Medicare “eligibility.” Process a Medicare claim, including an End-Stage Renal Disease (ESRD) claim if all factors of entitlement are met, but the U.S. lawful present requirement is not met. CMS is responsible for not paying Medicare services rendered to an alien who is not lawfully present in the U.S. https://secure.ssa.gov/apps10/poms.nsf/lnx/0300204010

  4. I’m self employed and haven’t filed taxes for years. I’m now filing so that I can get my 40 quarters in. I turn 65 in January 2020. Why is Medicare telling me I have to have everything in by September 30?

        • Well, 1st of all, I’m not a CPA and not allowed to give tax advice.

          Here’s research though, make your own interpretation and check with your CPA, Attorney and/or competent tax counsel.

          There’s a time limit for reporting Social Security earnings and getting credits towards future Social Security benefits. The time period is 3 years, 3 months, and 15 days following the end of the calendar year in which you earn the income. If your earnings are not reported within this time period, you will not accumulate any Social Security credits for the unreported income. https://www.ssa.gov/OP_Home/ssact/title02/0205.htm Colvin Hallett Law

          The Social Security Administration no longer mails out an annual Social Security Statement. In order to view your Social Security Statement, you must register on the Social Security Administrations website.

          The Balance.Com

          You earn work credits on the minimum $1,360 of earnings no matter when or how frequently you earn them. Theoretically, you could earn four work credits in a single month in which you make $5,440. That would max out your work credits for the year, however. Zacks.com

          Social Security Self Employed 10022

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