If you or your spouse has earned at least 40 credits through paying Medicare payroll taxes at work, essentially 10 years of work, you are entitled to Part A benefits without having to pay premiums for them. So you won’t have to pay Part A late penalties even if you sign up later than you should.
But if you aren’t eligible for premium-free Part A, you may have to pay a late enrollment penalty, except in certain circumstances. That’s why it’s important to sign up for Medicare when you are first eligible.
If you have paid Medicare taxes for fewer than 40 quarters and your spouse doesn’t have 40 quarters either, you will have to pay premiums to receive Medicare Part A coverage. In 2022, if you or your spouse paid Medicare taxes for 30 to 39 quarters, you’ll pay $274 a month for Part A. If you or your spouse paid Medicare taxes for fewer than 30 quarters, you’ll pay $499 a month for Part A.
If you do have to pay premiums for Part A, the late enrollment penalty is 10 percent of either $274 or $499, added to that monthly premium. But unlike Part B penalties, it doesn’t last forever.
Instead, you will 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 would pay penalties for six years.
So if you worked for fewer than 7½ years total, or 30 quarters, you would have to pay almost $50 more a month, 10 percent of $499, as your premium penalty in 2022. If you delayed your enrollment for three years and weren’t eligible for a special enrollment period, then you would have to pay the penalty for six years. Because Part A premiums usually rise each year, your penalty will generally rise each year, too.
If you don’t qualify for premium-free Part A, you may have to pay a late enrollment penalty if you don’t enroll in Part A during your initial enrollment period, which is the three months before to the three months after the month you turn 65. Here are the exceptions:
If you don’t yet qualify for premium-free Part A benefits and you don’t have health insurance from your or your spouse’s current employer, 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 as long as you have Medicare Part B. This rule applies to anyone who is a U.S. citizen or a permanent legal resident, also known as a green card holder.
Updated June 8, 2022
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