People qualify for Medicare Part A once they reach age 65 years. Individuals with end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) may be eligible before this age.
Medicare Part A covers hospital treatment and certain other treatments.
People become eligible to sign up for Medicare 3 months before the month of their 65th birthday. They can also apply during the 3 months following their birth month.
This article explains the eligibility criteria for Medicare Part A. It also looks at whether spouses are eligible based on their partner’s qualification for Medicare and the reasons why a person might not qualify for Part A.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Most people qualify for Medicare Part A when they reach age 65 years.
A person has a 7-month enrollment window. This time frame includes the 3 months before their birth month, the whole month in which their birthday takes place, and the 3 months afterward.
Applying outside this period means that a person will have to pay a higher premium.
If a person already receives retirement benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB), these organizations will automatically enroll the individual in Medicare Part A.
Learn more about Medicare eligibility criteria.
Some people can qualify for Medicare Part A before they are 65 years old.
Disability benefits
If a person has received disability benefits from the SSA or RRB for 25 months, they may qualify to receive premium-free Medicare Part A benefits.
For a person to qualify for Medicare under disability criteria, a healthcare professional must certify that they are living with a disability.
The eligible disabilities may vary and can include both physical and mental health conditions.
End-stage renal disease (ESRD)
If a person has ESRD and is on dialysis or has had a kidney transplant, they may qualify for premium-free Part A.
Medicare Part A coverage typically begins during the fourth month of dialysis, if that is a part of a person’s treatment.
Amyotrophic lateral sclerosis (ALS)
Those with ALS qualify for Medicare Part A. They often do not have to wait 24 months for eligibility.
A person will usually automatically start receiving Medicare Part A in the same month that they receive their disability benefits from the SSA or RRB.
Questions about Medicare eligibility
If a person has a question regarding their eligibility for Medicare Part A or other aspects of Medicare, they should contact the SSA at 800-772-1213 (TTY: 800-325-0778).
A person who is age 65 years or older may qualify for Medicare Part A benefits if their spouse has paid Medicare taxes for 40 quarters (10 years) of employment. This would entitle them to a premium-free Part A plan.
If a person is younger than their spouse and has not yet reached age 65 years, they cannot qualify for Medicare earlier based on their spouse’s eligibility, unless they have a qualifying disability.
For example, if a person is 62 years old and their spouse is 65 years old, the individual cannot obtain Part A benefits until reaching age 65 years themselves.
Learn more about Medicare coverage for spouses.
A person must be age 65 years or older to qualify for Medicare Part A. Unless they meet other requirements, such as a qualifying disability, they cannot get Medicare Part A benefits before this age.
Some people may be 65 years old but ineligible for premium-free Medicare Part A. For instance, a person who did not work for 40 quarters and pay Medicare taxes during that time would not be eligible.
If a person has paid Medicare taxes for 30 to 39 quarters, they can pay a reduced premium for Medicare Part A, at $278 per month, according to the Centers for Medicare & Medicaid Services. If a person has paid the taxes for fewer than 30 quarters, they may need to pay a $505 monthly premium.
Even without a premium, Medicare Part A is not a completely free insurance plan. Out-of-pocket costs still apply.
Read about Medicare Part A costs.
Medicare Part A covers hospital services and skilled nursing facility care. Examples of services that Medicare Part A may cover include:
- inpatient hospital care
- skilled nursing facility care
- nursing home care
- hospice care
- home healthcare
Medicare Part A does not cover long-term or custodial care. It covers only medical care that focuses on helping a person improve their overall condition.
Once a person has signed up for Medicare Part A, their coverage will usually begin in the month that they turn 65 years old. However, this may not always be the case, depending on when a person signed up for Medicare. For example, a person might not sign up until after their birth month, so coverage would begin after they have already turned 65 years old.
Learn more about what Medicare Part A covers.
A person may have to pay penalties for Medicare Part A if they enroll outside the initial enrollment window, which is the 7 months around a person’s birthday.
Medicare adds 10% to the premium for double the number of years for which a person did not sign up for Medicare Part A while eligible.
For example, if a person waits 3 years after reaching age 65 years to apply for Medicare Part A, their premium increase will last for 6 years.
It is best to apply during the initial enrollment window, as this makes Medicare plans more cost-effective.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part A is part of a government-funded health insurance plan. People are eligible for this part of Medicare if they have reached age 65 years or have a qualifying disability.
Depending on the number of quarters over which a person has paid Medicare taxes, they or a spouse of qualifying age may be eligible to receive Part A coverage without paying a premium.
People should enroll within a time frame that spans a 7-month period, with the month of their 65th birthday at the center. Registering outside this period may lead to a higher premium.