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En español | If you or your spouse has earned at least 40 credits through paying Medicare payroll taxes at work, you are automatically entitled to Part A benefits (which cover stays in the hospital, home health services and hospice care) and you do not pay premiums for them. Therefore you cannot be liable for late penalties, even if you sign up later than you should. Otherwise, you’d pay penalties, except in certain circumstances. 

Part A late penalties amount to an extra 10 percent of your current Part A premium added to the premium. Part A premiums are expensive — in 2017, they are $227 a month if you’ve earned 30 to 39 work credits, or $413 a month if you have fewer than 30 credits. However, unlike Part B late penalties, that 10 percent is not multiplied by the number of years you delayed enrollment, and you don’t have to pay them forever. You continue to pay Part A penalties for twice the number of years that you could have paid premiums for Part A but didn’t. For example, if you delayed enrollment for three years, you’d pay penalties for six years.

There are some exceptions: 

  • If you receive health care coverage from an employer for which you or your spouse actively works, you have the right to delay Part A as well as Part B enrollment until the employment ends. By that time, if you or your spouse has earned 40 work credits, you can sign up for Part A without paying premiums or incurring late penalties. If neither of you has earned 40 credits by then, you will not pay late penalties retroactively, but you must enroll in Part A during your eight-month special enrollment period to avoid penalties going forward. 
  • If you receive Medicaid, the state-run health program for people with incomes under a certain level, you do not pay Part A premiums and cannot pay late penalties.
  • If your state pays your Part A premiums, under one of the Medicare Savings Programs, you are not liable for late penalties. 
  • If you live outside the United States and are not entitled to premium-free Part A benefits, you cannot enroll in Part A or Part B abroad. Instead, you get a special enrollment period of up to three months after your return to the U.S. to sign up. If you enroll in Part A at that time, you are not liable for late penalties. 

One important point: If you don’t yet qualify for Part A benefits without paying premiums, and you’re not covered under current employer health insurance, don’t be tempted to delay enrollment in Part B (which covers doctors’ services, outpatient care and medical equipment) until you become entitled for premium-free Part A. If you delay, you will likely receive Part B late penalties, which you’ll have to pay for all future years. This rule applies to anyone who is a U.S. citizen or a permanent legal resident (green card holder).  


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