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

  • February 24, 2018

Q: Who does NOT 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 amylotrophic 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.

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If you do have to pay Part A premiums, you’ll pay either $232/month (if you or your spouse paid Medicare payroll taxes for at least 7.5 years, but fewer than 10 years) or $422/month (if you or your spouse paid Medicare payroll taxes for fewer than 7.5 years).

Everyone pays for Part B of Original Medicare; in 2018, the standard premium is $134/month for those making less than $85,000 per year ($170,000 per year for married couples filing jointly), but most enrollees actually pay a little less, averaging about $130/month. Beneficiaries with higher incomes pay more for Medicare B, and people who don’t enroll in Medicare B when first eligible will be 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.)