How do I buy Medicare Part A Hospital if I don’t have 10 years of working?
No Premium Medicare Part A – Hospital
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.
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 *
Are there Alternatives to paying $471/month? Medicare.Gov
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 don’t have enough credits and have to buy Part A, you’ll pay the Part A premium aka Premium Part A which runs up to $506 each month Medicare.Gov *
- How to earn Social Security – Medicare Credits Publication # 10072 *
Watch out for penalties if you don’t enroll when you are supposed to.
- If you qualify for Medi Cal, Medi Cal might pay your Medicare Premiums
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
Don’t have 5 years? ACA/Obamacare Quotes
- Our Quote Engine Takes all the complexity out of using pencil and paper to figure out the premiums per the Obamacare/ACA rules under CFR §1.36B-3 *
- Get more detail on the Individual & Family Carriers available in CA
- Amplicare.com Medicare Part D Rx Late Enrollment LEP Penalty Calculator
Visit Our Web Pages on:
- 2022 Official Medicare Guide to choosing a Medi Gap Policy # 02110
- Anthem Blue Cross Information & Enrollment
- United Health Care
- Blue Shield – Medi-Gap Information & Enrollment
- Your Rights to Enroll without Health Questions
Medi Gap pays the medical expenses that Original Medicare Part A (Hospital) and Part B (Doctor) doesn't. Check out the chart on this page to see what Medicare Pays, what you pay and what a Medi Gap plan pays.
Original Medicare, Medicare Advantage nor Medi Gap pay for long term care either in a nursing home or at home care. Get more information on Long Term Care here. Even if you think you can't afford any extra premiums, there's a lot of valuable information to help with planning.
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.
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.
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).
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).
Medicare #Enrolling in Parts A & B # 11036
- Welcome to Medicare 2022 Publication # 11095
- Our webpage on Enrolling ONLINE for Medicare Part A Hospital & B Doctor Visits
- Part A Hospital rules for zero premium
- Part B – Doctors – How to sign up – Benefits
- How to apply for Part B when you lose employer coverage - 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
FAQ's from Medicare.Gov
It depends on the type of health coverage you may have.
- Deciding to Sign Up for Medicare Part B VIDEO
- You must pay your Part B premium every month for as long as you have Part B (even if you don’t use it).
- If I'm low income - are there any breaks?
- Interactive Q & A from IRS on when to sign up for Medicare
- I have coverage through my spouse who is currently working.
- I have retiree coverage (from my former employer or my spouse’s former employer) or COBRA coverage.
- I have TRICARE, and I'm a retired service member.
- I have TRICARE, and I'm an active-duty service member.
- I have CHAMPVA.
- I have End-Stage Renal Disease (ESRD).
- I have Marketplace Covered CA or other private insurance.
- I don't have any of these.
- 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
- FAQ's that we did
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
(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:
- 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?
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.
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.
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.
- 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.