Natasha is turning 65 in a few months and wants to enroll in Medicare because she has no other insurance. She has never worked in the U.S. and is worried about the costs. She knows that people who have fewer than 10 years of work history in the U.S. may owe a premium for Part A. Her husband Eric is 58 and has worked in the U.S. for over 25 years.
Is Natasha eligible to enroll in Medicare when she turns 65? Will she qualify for premium-free Part A?
What To Do:
Yes, Natasha is eligible to enroll in Medicare when she turns 65. She can enroll starting three months before she turns 65, the beginning of her Initial Enrollment Period (IEP).
Although work history does not affect someone’s eligibility for Medicare, it does affect how much someone pays for the Part A premium. Based on her own work history, Natasha does not qualify for premium-free Part A. However, she can use Eric’s work history to qualify for premium-free Part A once he is eligible for Social Security benefits. Eric will be eligible for Social Security benefits when he turns 62 or becomes eligible to receive Social Security Disability Insurance (SSDI). Until then, Natasha will owe a premium for Part A. Note that Eric does not have to be collecting Social Security benefits in order for Natasha to use his work history—he just has to be eligible for them.
To avoid possible late enrollment penalties and gaps in coverage, Natasha should enroll in premium Part A and Part B during her IEP.
What if Natasha cannot afford the Part A premium?
If Natasha cannot afford the Part A premium, she may decide to enroll in Part B and wait to enroll in Part A until Eric is eligible for Social Security benefits. Before delaying premium Part A enrollment, Natasha should carefully consider three things:
- Her need for Part A-covered services. Without Part A, Natasha will not have coverage for services like inpatient hospital care or skilled nursing facility care. She will have to pay out of pocket for the cost of those services.
- Possible gap in coverage. If Natasha wants or needs to enroll in premium Part A before she qualifies for premium-free Part A, she may have to use the General Enrollment Period (GEP) to enroll. The GEP runs January 1 through March 31 of each year, and coverage does not start until July 1 of that same year.
- Premium Part A late enrollment penalty. If Natasha delays enrollment in premium Part A, she may have a late enrollment penalty if she decides to enroll later. The Part A penalty is 10% of the Part A premium after the first 12-month period that Natasha did not enroll in premium Part A. It lasts for twice the number of years that Natasha was eligible for premium Part A but did not sign up. Natasha will not have a penalty when she becomes eligible for premium-free Part A.
If Natasha and Eric have limited income and assets, Natasha may qualify for assistance to pay the Part A and/or B premiums through the Medicare Savings Program (MSPs).