Medicare Part A is generally available to people age 65 or older who meet Medicare’s citizenship or residency rules, and some people can qualify earlier because of disability, ALS, or End-Stage Renal Disease (ESRD). Whether you pay a monthly premium for Part A depends on your work history or a qualifying spouse’s work history.
What is Medicare Part A?
Part A is the hospital insurance portion of Medicare. It helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Who is eligible for Medicare Part A?
You may be eligible for Part A if you are 65 or older and meet Medicare’s citizenship or residency requirements. Some people under 65 may also qualify because they receive disability benefits, have ALS, or have ESRD.
Eligibility for Part A is separate from the question of whether it is premium-free.
Who can get premium-free Part A?
Many people do not pay a monthly premium for Part A. Medicare explains that premium-free Part A is usually available if you or another qualifying person, such as a current or former spouse, paid Medicare taxes while working long enough—generally at least 10 years for eligibility at age 65.
Medicare also notes that if you qualify for Medicare before age 65, you generally do not pay a Part A premium.
Can you buy Part A if it is not premium-free?
Yes. If you do not qualify for premium-free Part A, you may still be able to buy it. The amount can vary based on how long you or your spouse worked and paid Medicare taxes, so it is important to check current figures directly with Medicare or Social Security rather than relying on older dollar amounts.
When can you sign up for Part A?
For most people, the first chance to enroll begins 3 months before the month they turn 65 and ends 3 months after that month. If you are already getting Social Security or Railroad Retirement Board benefits early enough, Part A may start automatically when you become eligible. If not, you usually need to sign up through Social Security.
Some people sign up for Part A later. Medicare says premium-free Part A can be taken any time after age 65, and in that situation coverage can begin retroactively for up to 6 months, but not earlier than the month you turned 65.
How do people qualify before age 65?
| Situation | How Part A eligibility works |
|---|---|
| Disability | People under 65 generally become eligible after receiving qualifying Social Security disability benefits for 24 months. Qualifying Railroad Retirement Board disability benefits can also establish eligibility. Different rules apply to ALS and ESRD. |
| ALS | Medicare says coverage starts automatically the same month Social Security disability benefits begin. |
| ESRD | Medicare says eligibility and start timing depend on the ESRD rules and whether you are on dialysis or getting a transplant. |
Important timing issue: HSA contributions
If you enroll in Medicare after age 65, Part A can start up to 6 months before your application date. Medicare warns that people with a Health Savings Account should pay close attention to this because you cannot make HSA contributions after you have Medicare.
Checklist: how to confirm your Part A eligibility
- Confirm whether you are 65 or older, or may qualify earlier because of disability, ALS, or ESRD.
- Check whether you meet Medicare’s citizenship or residency requirements.
- Review your own work history and your spouse’s or former spouse’s work history for Medicare taxes.
- Find out whether you will get Part A automatically or must apply through Social Security.
- If you are over 65 and use an HSA, verify the effect of retroactive Part A before you apply.
FAQ
Does everyone get Part A for free?
No. Many people qualify for premium-free Part A, but some may need to buy it.
Can I get Part A before age 65?
Yes, in certain situations, including qualifying disability, ALS, or ESRD.
Do I sign up through Medicare or Social Security?
Medicare provides the coverage, but Social Security or the Railroad Retirement Board handles Part A and Part B enrollment.
Buying Part A also requires Part B
If you buy Part A because you do not qualify for premium-free coverage, you must also enroll in or already have Part B. You must keep Part B and pay both required premiums to maintain premium Part A. Check the current premiums and any assistance you may qualify for before enrolling.
Related coverage questions
- How to Enroll in Medicare: Steps, Timing and Where to Get Help
- Who Is Eligible for Medicare? Age, Disability and Enrollment
- How to Verify Your Medicare Coverage and Plan Enrollment