To get premium free Medicare Part A, you or your spouse must have worked and paid Medicare taxes for 10 cumulative years or have a qualifying disability. Most U.S. citizens automatically receive Part A after turning 65, which covers inpatient care provided in the following environments:
- Hospitals
- Skilled nursing facilities
- Nursing homes
- Hospice
- Home health care
Part A benefits include inpatient room and board, lab tests, supplies, and surgery. If you do not qualify for premium-free Part A, you can purchase it for a $278 or $506 monthly premium relative to your work history. Some people with limited income or disability records can apply for Part A premium assistance through their state-operated Medicare Savings Programs.
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What Is the Medicare Tax?
The Federal Insurance Contributions Act (FICA) levies a 15.3% combined payroll tax – a 12.4% Social Security tax and a 2.9% Medicare tax – on all working citizens. Employers must pay exactly half of this rate, leaving workers with a 7.65% pretax contribution withheld from their paychecks. Self-employed individuals pay this on their tax return as part of the Self-Employed Contributions Act (SECA).
Much of Medicare’s funding comes from the 1.45% Medicare FICA taxes working citizens pay throughout their lives. Specifically, these contributions cover the cost of providing premium-free Part A to 99% of Medicare beneficiaries.
How Premium Free Part A Works
Your access to premium-free Part A will vary depending on your work history and financial eligibility.
Eligibility
To access premium-free Part A, you must meet the following criteria:
- You receive retirement or disability benefits from the Social Security Administration or the Railroad Retirement Board.
- You are 65 or older, are younger than 65 but receive SSDI, or have ESRD.
- You or your spouse had Medicare-covered employment.
- You or your spouse paid your share of Medicare taxes.
To meet your tax obligation, you or your spouse must have independently earned 40 quarters of coverage (QCs) through at least 10 years of legitimate labor. For example, if you worked 39 quarters and your spouse worked 5, you would have to pay for Part A. However, if you worked 40 quarters and your spouse worked 0, you could both secure Part A free of charge.
How Is Premium Free Part A Funded?
The Medicare Hospital Insurance (HI) Trust Fund funds all premium-free Part A policies. Most savings in this account come directly from payroll taxes paid by employees, employers, and self-employed individuals. Whereas employees and their employers evenly split the 2.9% Medicare tax, self-employed individuals pay it in full but deduct half on their annual return.
The HI Trust Fund guarantees U.S. citizens affordable health insurance when they become old and need it most. In addition to FICA contributions, the HI account also receives funding from the following:
- Income taxes paid on Social Security benefits
- Interest earned on trust fund investments
- Monthly payments from Medicare recipients without premium-free Part A
What If You Worked Less Than 40 Quarters?
Anyone who has earned less than 40 QCs must pay for Medicare Part A. However, if you contributed 30-39 quarters of Medicare taxes before turning 65, you will still qualify for a discounted Part A premium of $278. People in this category usually have worked the equivalent of 7.5 to 10 years full-time.
What If You Worked Part-Time?
If you only worked part-time for most of your life, you will likely have to pay for Medicare Part A in full. In 2023, individuals with less than 30 QCs owe a $506 monthly Part A premium. However, you can still access a discounted or rescinded premium if your legal spouse has earned over 30 QCs.
Is Part A Without Premiums Really Free?
Considering you contribute 1.45% of your lifetime earnings to Medicare, Part A can hardly be classified as “free.” Likewise, even people with premium-free Part A must pay their annual $1,600 deductible before accessing benefits. Others who require prolonged hospital stays would also owe a daily copayment that can increase over time.
For example, if you became hospitalized for 100 days, Part A would cover 100% of the cost of your first 60 days after meeting your deductible. You would then owe a $400 daily fee for the next month and $800 for each of the final 10 days. You would lose Part A coverage entirely after any inpatient stay exceeding 150 days, leaving you to foot the remainder of the bill out-of-pocket.
How Much Does the Part A Premium Cost?
If you must pay for Medicare Part A, costs will vary depending on your and your spouse’s independent work histories.
Your Part A Monthly Premium | |
|---|---|
You or your spouse worked between 30-39 QCs | $278 |
You worked under 30 QCs | $506 |
Supplementing Your Part A Coverage
Original Medicare members can purchase private Medigap plans to help reduce their deductibles, copayments, and coinsurance. The following Medigap policies fully absorb the Part A deductible and cover an extra 365 days of hospital care:
While they provide similar benefits, Plans K and M only cover 50% of your Part A deductible. Plan L only pays 75%, whereas Plan A absorbs 0%.
Because Original Medicare does not include prescription drug benefits, many seniors also purchase optional Part D coverage. These private policies pay for a percentage of eligible medications named in their drug formulary.
Is It Possible To Get Free Medicare Part B?
Though many seniors automatically qualify for premium-free Part A, most others must pay for Part B. Part B costs $164.90 for every month in 2023, covering 100% of preventative care and 80% of outpatient doctors’ services, diagnostic tests, and medical equipment after members meet their $226 annual deductible.
In exceptional cases, some individuals might qualify for free Medicare Part B after enrolling in a Medicare Savings Program (MSP). While these state-operated initiatives mainly help reduce Part A and Part B monthly premiums, they occasionally pay for part or all of your <a class=”wpil_keyword_link” href=”https://assurance.com/health-insurance/copays-deductibles-and-coinsurance, copayments, and deductibles.
How To Get Help Paying For Part A
If you did not contribute the required share of FICA taxes throughout your life, you can still get help paying for Part A through one of four different Medicare Savings Programs.
Qualified Medicare Beneficiary Program (QMB)
The QMB program helps pay Part A and Part B premiums, deductibles, copayments, and coinsurance for any items or services covered under Medicare. To receive QMB assistance, you must make under $1,235 monthly and have less than $9,090 in stocks, bonds, and savings. QMB enrollees also jointly receive Medicare Extra Help, reducing prescription costs to $4.30 out-of-pocket for each covered drug.
Specified Low-Income Medicare Beneficiary Program (SLMB)
While the SLMB program only helps cover Part B premium costs, you must have both Medicare Part A and Part B to qualify for assistance. To access these benefits, you must have a monthly income under $1,478 and possess at most $9,090 in eligible resources. SLMB beneficiaries also receive Extra Help coverage that reduces prescription costs to $10.30 or less for every covered drug.
Qualified Individual Program (QI)
Like the SLMB program, QI programs only reduce Part B monthly premiums and prescription drug costs for people enrolled in both parts of Original Medicare. These individuals must have a monthly income under $1,660 and reapply for QI benefits yearly. Notably, state QI programs always prioritize the applications of previously enrolled members over newcomers.
Qualified Disabled and Working Individuals (QDWI) Program
The QDWI program only helps cover Medicare Part A premiums for people who meet the following criteria:
- They have a disability
- They still go to work
- They lost SSDI benefits and premium-free Part A eligibility after returning to work
Qualified candidates can make up to $4,945 each month and have up to $4,000 in stocks, bonds, and savings and still receive QDWI benefits.
All in All
Medicare is a federally funded health insurance program for seniors over 65 and some younger people with qualifying disabilities. While many beneficiaries must pay for Medicare Part B, most people automatically receive Medicare Part A free of charge immediately after becoming eligible.
However, some individuals with limited work and tax histories must pay a monthly Part A premium. While members can postpone this coverage, doing so often results in late enrollment penalties. If you need help determining your options, call 1-800-MEDICARE to ask about your eligibility for premium-free Part A or cost-saving benefits available through the Medicare Savings Programs.