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Who does NOT have to pay a premium for Medicare Part A?

Who doesn't have to pay a premium for Medicare Part A?

A: Most Medicare-eligible people do not have to pay premiums for Medicare Part A. If you are 65 and you or your spouse has paid Medicare taxes for at least 10 years, you don’t pay a premium for Part A.

You may also not have to pay the premium:

  • If you haven’t reached age 65, but you’re disabled and you’ve been receiving Social Security benefits or Railroad Retirement Board disability benefits for two years.
  • You have end-stage renal disease (ESRD) and are receiving dialysis, and either you or your spouse or parent (if you’re a dependent child) worked and paid Medicare taxes for at least 10 years. Coverage typically begins the first day of your fourth month of dialysis, but it can begin in your first month of dialysis if you use in-home dialysis treatment.
  • You have amyotrophic lateral sclerosis (ALS) and are eligible for Social Security Disability Insurance (SSDI). Medicare coverage begins as soon as your SSDI begins, and Medicare Part A has no premiums as long as you or your spouse (or parent, if you’re a dependent child) worked and paid Medicare taxes for at least 10 years.

How much are Medicare Part A premiums in 2020?

If you do have to pay Part A premiums in 2020, you’ll pay either $252/month (if you or your spouse paid Medicare payroll taxes for at least 7.5 years, but fewer than 10 years) or $458/month (if you or your spouse paid Medicare payroll taxes for fewer than 7.5 years). These premiums are adjusted annually.

Everyone pays for Part B of Original Medicare. In 2020, the standard premium is $144.60/month for those making no more than $87,000 per year ($174,000 per year for married couples filing jointly). For 2020, the threshold for having to pay higher premiums based on income increased. (Beneficiaries with higher incomes pay more for Medicare Parts B and D).

People who don’t enroll in Medicare B when first eligible are charged a late enrollment penalty that amounts to a 10 percent increase in premium for each year they were eligible for Medicare B but not enrolled. So if you wait until three years after you’re eligible to enroll, you’ll pay 30 percent more than the standard premium for Medicare B, for as long as you have the coverage. But this penalty does not apply if you delayed your Part B enrollment because you had employer-sponsored coverage from a current employer (or your spouse’s current employer) and used that coverage instead of Part B.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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2 years ago

I just heard that senior citizens who have Original Medicare and worked in NYC in the Dept. of Education do not need to have a supplement policy for Part B coverage to pay for the 20% that Part A does not cover. WOW! I pay $331 a month for a supplement policy because I want Original Medicare and coverage for the unpaid 20%.

How come NY employees do not pay for a Supplemental policy?

Also, Who pays the Part A premium for Original Medicare? Is it payed out of my monthly Social Security?

Thank you.

Brigitte G Ware
1 year ago

What is the criteria NOT to pay the 148.50 for medicare part a

Editor
1 year ago

The $148.50/month is for Medicare Part B, not Part A (most people get Part A for free, but most people have to pay $148.50/month for Part B in 2021). But if you qualify for a Medicare Savings Program, you may be able to get assistance with your Part B premium. Here’s more information about that: https://www.medicareresources.org/faqs/is-there-help-for-me-if-i-cant-afford-medicares-premiums/

Debbie Stewart
1 year ago

Why do poor people have to pay any supplement or deductible?

leroy markley
9 months ago

why do i pay for medicare when i don;t use it. i have humana ins.

i’m told not to use my medicare card, so why do i pay for it. i’m paying for something i’m not using

Tanya Feke, MD
9 months ago
Reply to  leroy markley

By Humana insurance, I assume you mean you have a Medicare Advantage plan. Anyone who is on a Medicare Advantage plan must continue to pay Part A and Part B Medicare premiums. Most people get Part A premiums for free but most everyone else pays for Part B (unless they are on Medicaid too or they qualify for certain Medicare Savings Programs).

This can be confusing because you are told you can be on Original Medicare (Part A and Part B) or a Medicare Advantage (Part C) plan, not both. To understand why you still need to pay Part A and Part B premiums when you are on Medicare Advantage, you need to understand a bit more about how the system works.

Medicare Advantage plans are run by private insurance companies, like Humana, but they still work closely with the government. First, the plan signs a contract with the government. This contract makes sure that the plan covers certain services and at reasonable rates. Then, the government pays the plan a certain amount for each person it covers. The money that comes in through your Part A and Part B premiums helps the government to pay these plans for part of your care. When you think about it, this is why so many Medicare Advantage plans are able to offer plans in 2022 that do not require you to pay them a premium directly. They are already getting paid on the back end.

*Keep in mind the government is not paying these plans for everything. These plans will still charge you for care.

Because Part A and Part B are helping to fund your health care, you are not eligible for a Medicare Advantage plan unless you are enrolled in Part A and Part B. If you do not pay your Part A and Part B premiums, you will lose your Medicare Advantage coverage.

Last edited 9 months ago by Tanya Feke, MD
Eugene Knox
6 months ago

I am not on medicare a& b i have insurance through my spouses work and pay a good amount for insurance but i get none of the government freebies because i am not on medicare i thought every one is created equal?

Editor
6 months ago
Reply to  Eugene Knox

Medicare is not free. Workers pay into the system throughout their careers, and then receive coverage once they turn 65. But even then, they have to pay a premium for Part B, and most enrollees also pay a premium for private Part D coverage as well as Medigap coverage (or Medicare Advantage coverage, if they pick an Advantage plan that has a premium).

If you’re not yet 65, you’re probably not eligible for Medicare. But you will be once you’re 65, and you’ll be able to enroll based on your spouse’s work history, even if you don’t have your own work history. If you’ve already turned 65, you can likely enroll in Medicare Part A for free, based on your own or your spouse’s work history. Medicare Part B would also be available to you, although there are several points to keep in mind regarding Part B if you still have active employee coverage: https://www.medicareresources.org/medicare-eligibility-and-enrollment/why-you-cant-afford-to-get-medicare-part-b-wrong/

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