Medicare Hospital Insurance

To provide hospital insurance protection for covered services to persons age 65 or above, to certain disabled persons and to individuals with chronic renal disease.

To provide hospital insurance protection for covered services to persons age 65 or above, to certain disabled persons and to individuals with chronic renal disease.

Persons age 65 or over and certain disabled persons are eligible to receive hospital insurance benefits. Nearly all individuals who had reached the age of 65 before 1968 are eligible for Part A, including people not eligible for cash Social Security benefits. A person reaching the age of 65 from 1968 to the present, and who is not eligible for social security benefits, needs to have accumulated work credits (amount dependent on age) to qualify for hospital insurance benefits. Hospital insurance (Medicare Part A) is also available to persons aged 65 and over through payment of a monthly premium, which is currently $518 per month, effective January 1, 2025. A reduced Part A premium of $285 per month is applied to persons with 30 to 39 quarters in which they have paid into the social security system. This reduced Part A premium applies to their spouse, surviving spouse or divorced spouse as well. Federal employees began contributing toward Medicare hospital insurance coverage in 1983. Employees who have worked in the federal government prior to this year are still eligible to receive credit for prior non-contributory quarters of Federal employment. State and local government employees not already in Social Security-covered positions and who were hired on or after April 1, 1986 also contribute toward Medicare hospital insurance coverage. Although states may request agreements to cover individuals employed prior to April 1, 1986, no credit is given toward establishing Medicare entitlement for prior employment. Persons under the age of 65 who have been entitled to Social Security or Railroad Retirement disability benefits for at least 29 months are also eligible to receive hospital insurance benefits, as are any individuals who have been diagnosed with End Stage Renal Disease (ESRD).

Persons age 65 or over and qualified disabled persons.

Hospital insurance benefits are paid to participating hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, and hospice agencies. Payments are made in order to cover the prospective payment amount or reasonable cost of medically necessary services furnished to individuals who are entitled under this program. In limited circumstances, Medicare will also pay for certain aspects of receiving care in an inpatient religious non-medical health care setting.

The individual will be notified by mail of enrollment, whether automatic or applied for.

Telephone or visit the local Social Security Office or Medicare payment organization responsible for the initial determination. The appeal process ranges from reviews of the initial determinations to formal hearings and, in cases meeting certain criteria, reviews by Federal Courts.