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Who Qualifies for Premium-Free Medicare Part A?

Written by Jason Patterson

There are two main parts of Medicare, A and B. Each of these are components of Original Medicare and provide healthcare coverage to millions of Americans. Each part covers different expenses, but also has different premium amounts. If you’re about to enroll in Medicare, it’s vital that you understand exactly how much you’ll be paying for your health care coverage.

Most of the medicare enrollees will have their Part A coverage for free, there are some who may be required to pay up to $426 per month for this health care coverage. These individuals are the ones who did not pay Medicare taxes into the system while they were working.

Who qualifies for medicare part AIn order to qualify for premium-free Medicare Part A, there are several criteria that must be met. These include the following. If you and / or your spouse paid Medicare taxes while you were working, and you are age 65, you will receive Medicare Part A coverage without paying a monthly premium provided that:

  • You receive SS benefits or retirement from the rail road
  • You are eligible to receive Social Security retirement income benefits, or retirement income benefits from the Railroad Retirement Board, but you have not yet filed for them
  • You and / or your spouse worked in Medicare-covered government employment.

There are also certain individuals who may be able to receive Medicare Part A without the need to pay a premium if they are under the age of 65. Qualifications for this are if the person is on Social Security, disability for at least 24 months, or if someone has been diagnosed with ESRD.

In most instances, if a person opts to purchase Medicare Part A coverage, he or she will also be required to have Medicare Part B. In doing so, they will then be paying a monthly premium for both parts of Medicare. (Medicare Part A and Part B are also referred to as Original Medicare). As an option with helping to cover the costs that parts A and B do not cover you can look into Medigap Supplement Plans, such as Medicare Part F which is the most comprehensive of the supplemental plans.

How to Apply for Medicare Part A Coverage

There are many ways to qualify automatically for Medicare Part A coverage, as well as coverage in Medicare Part B. In addition to being under age 65 and having a qualifying disability, or being age 65 and receiving Social Security or Railroad Retirement Board benefits, other ways to automatically qualify include:

  • An individual has Lou Gehrig’s Disease (Amyotrophic Lateral Sclerosis)
  • An individual resides in Puerto Rico and they already receive Social Security or Railroad Retirement Board retirement income benefits

While there are some people who will be automatically enrolled in Medicare Part A, there are others who will need to sign up for it. Those who are required to actually sign up for Medicare Part A include those who:

  • Are not already receiving retirement income benefits from Social Security or from the Railroad Retirement Board (because they are not yet retired and are still actively working)
  • May qualify for Medicare because they have End Stage Renal Disease
  • Live in Puerto Rico and wish to apply for Medicare Part B coverage. (In this case, the individual must already be enrolled in Medicare Part A in order to apply for Medicare Part B coverage).

Because the vast majority of people will already be receiving Social Security benefits, most people will automatically be enrolled in Part A. If you fall under one of the categories, it’s vital that you sign up for Part A. Not enrolling under your initial period could have several consequences. Not only could you be facing penalties for a late enrollment, but you could also have gaps in your coverage that leave you paying for certain medical bills out-of-pocket.

Part A Coverage

It’s important to understand what expenses Part A is going to pay for when you’re enrolling in the program, it can eliminate any confusion down the road. Part A provides for a lot of expenses that could drain your saving account otherwise. Some of the expenses that Part A covers is hospital care costs, skilled nursing facility care expenses, nursing home costs, Hospice care costs, and a few additional expenses.

If you have any questions about services that you are receiving, or are about to start receiving, and you’re wondering if it’s going to be covered by Medicare, either Parts A or B, there are two simple ways that you can find out. The first is to ask your doctor or physician if it’s going to be paid for by Medicare reimbursement. Sometimes Medicare may not cover certain procedures or exams, but your physician should be able to give you guidance based on your specific scenario.

The other way to determine if Medicare will cover the costs of your treatment or services is by going to the official Medicare website and using their tool. Simply type in the treatment and the website be able to explain the Medicare coverage for that specific item/service.

As you can see, Medicare Parts A and B don’t cover every expense that you’ll run into. If you want more coverage than Medicare offers, an excellent way of getting that is by purchasing a medsup plan through the private insurance companies that sell them or through an insurance agent. With ten options available you should find something to fit your needs.

Our agents are dedicated to giving you the knowledge and resources you need to get the health care coverage you deserve.

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Jason Patterson has been in the insurance industry for over fifteen years. Starting in 2005, he became one of the first agents to sell medicare supplements online. From that small start, he grew an agency that helped thousands of people with their insurance needs in all fifty states.

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