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MEDICARE MADE EASY
I’m 70. I have only retiree health insurance and not enough quarters to qualify for premium-free Medicare Part A. If I return to work to earn the missing quarters, will I have to pay a late-enrollment penalty when I eventually join Medicare?
The answer is: Probably. Most people qualify for premium-free Part A if they (or their spouse) paid Federal Insurance Contributions Act (FICA) taxes during their working years. If you do not have enough credits for paying FICA (usually 40 credits, or 10 years of work), you will have to pay a premium for Part A. The amount varies based on the number of credits you have (in 2024, $505 a month for less than 30 credits, $278 a month for 30–39 credits).
If you delay enrollment into Part A because you or your spouse are actively working and covered by employer insurance, and you earn enough credits by the time you stop working, you won’t have to pay a late-enrollment penalty when you first enroll and can get Part A premium free. But Medicare does not count COBRA or retirement insurance, and if you’ve used one of those coverages, you must pay a penalty. For Part A, this penalty is 10 percent of the highest premium, and you pay it for twice the number of years you weren’t signed up.
My husband had a stroke and needs to go to a skilled nursing facility. Is there a way I can check which local ones accept Medicare and are high-quality?
Skilled nursing facilities (SNFs) are a valuable tool to help people with rehabilitation needs after a hospital stay. Though SNFs may be cohoused in nursing homes, they are intended to provide short-term inpatient services before the patient returns home.
Medicare has a comparison tool that helps you assess SNFs in your area. Go to medicare.gov/care-compare and click on “Nursing homes including rehab services” to search by ZIP code. The tool lets you compare quality scores and learn more about the types of conditions treated. Just a reminder: For Medicare Part A to cover your husband’s stay in an SNF, he must have spent at least three nights as a hospital inpatient and enter the facility within 30 days of leaving the hospital.
I’ve heard that next year the “doughnut hole” is closing for good and there’s a cap on how much I’ll pay for medications. Is that true?
Yes, it’s true. The doughnut hole—or Part D coverage gap—happens when a drug plan imposes a limit on what they’ll cover for prescriptions. Once you and the plan have spent up to a certain amount ($5,030 for covered drugs in 2024), you enter the doughnut hole. In this gap, you pay 25 percent of the cost of your prescriptions until you reach the maximum out-of-pocket spending limit. The Inflation Reduction Act of 2022 included a provision to close the doughnut hole for good. Beginning in 2025, you will not pay more than $2,000 out-of-pocket for your Medicare-covered drugs.
Brandy Bauer is former director of health coverage and benefits for the National Council on Aging, and writes frequently on Medicare and other government programs. Send your questions about Medicare to medicare@aarp.org. Due to the volume of inquiries, we can’t answer every question.
MEDICARE RESOURCES
MEDICARE HOTLINE:
800-Medicare (800-633-4227)
MEDICARE ONLINE:
medicare.gov