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Enrolling in Medicare – Things You Need to Know

By August 13, 2023September 23rd, 2023Enrollment, Medicare
Enrolling in Medicare – Things You Need to Know

Part A – Not Always Free


This is the second in a four-part series of things that you need to know when enrolling in Medicare and deals with eligibility for free Part A Medicare coverage. As a refresher – Part A Medicare generally covers the cost of inpatient hospital care, skilled nursing facilities, hospice care and some home care. There is a requirement for the beneficiary or their spouse to have paid payroll taxes a minimum of 40 quarters (10 years in total) to qualify for premium free Part A coverage. Part A has a complicated payment pattern of deductibles, time periods and co-pays in addition to the premium, which are not free, but can be covered, in whole or in part, through Supplements or Advantage Plans.

A summary of Part A Deductible and Cost Sharing follows:

Part A Deductible and Copays for Calendar Years 2022 and 2023
Inpatient hospital deductible$1,556$1,600
Daily copays for 61st-90th days$389$400
Daily copays for lifetime reserve days$778$800
Skilled nursing facility copay$194.50$200.00

Eligibility and premiums for Part A are based on actual employment, with payment into Social Security payroll taxes for 40 quarters. If you are married for more than 10 years, or widowed, and your spouse qualifies, then you qualify as well – provided you do not remarry. These requirements can be very difficult to women who work in the home and do not pay regularly into Social Security. I have seen cases of women who must pay full premiums for Part A who met the requirements but were married for 9 years, 11 months. Teachers and other municipal workers also frequently did not receive credit for work, as their payment was made into municipal pension plans instead of Social Security.

The premiums for Part A are shown below:

Part A Monthly Premiums
 20222023Annual Total
40+ Quarters of payment into Social Security$0$0$0
30 – 39 Quarters of payment into Social Security$274$278$3,336.00
Less than 30 quarters of payment into Social Security$499$506$6,072.00

Part A is an essential benefit, and it is free for 99% of beneficiaries. Most of those who do not receive free Part A are women who have worked in the home, “off the books”, and have not met the 10-year test through marriage. Be very careful – this is a large avoidable expense.

Wes Chapman

Wes Chapman was educated in Mexico and Spain, then had a 20-year career in investment banking in Latin America, finishing with 10 years as region director for Oppenheimer in Latin America. He spent the last 20 years in healthcare, focused on patient-centric, value-based care. He started Fortende to address the unmet needs of Medicare beneficiaries spending time outside the U.S.

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