Providing Group Health Insurance and Medicare Options. Licensed in GA, NC, SC, FL and CO
Medicare Part A
Need to know for Medicare Part A 2025 and possible changes in 2026
Understanding Medicare Part A
As an independent insurance agent in Augusta, GA, I want to ensure you have a clear understanding of Medicare Part A. Below are key details organized by topic.
🧍♂️ Who Qualifies
Most people become eligible for Medicare Part A when they turn 65 years old, but there are other ways to qualify:
- Age 65 or older and:
- A U.S. citizen or permanent legal resident for at least 5 years
- Eligible for Social Security or Railroad Retirement benefits
- A U.S. citizen or permanent legal resident for at least 5 years
- Under 65 and:
- Have received Social Security Disability Insurance (SSDI) for 24 months
- Have ALS (Lou Gehrig’s Disease) – automatic enrollment at diagnosis
- Have End-Stage Renal Disease (ESRD) and meet specific requirements
- Have received Social Security Disability Insurance (SSDI) for 24 months
💲 What the Cost Is
Most people get Medicare Part A premium-free if:
- They (or a spouse) worked and paid Medicare taxes for at least 10 years (40 quarters)
If you don't qualify for premium-free Part A, you can still purchase it:
- 2025 Premiums (subject to change in 2026):
- $0 if you have 40 quarters of work
- $278/month if you have 30–39 quarters
- $505/month if you have fewer than 30 quarters
- $0 if you have 40 quarters of work
Other potential costs:
- Deductible: $1,632 per benefit period
- Hospital Stay Coinsurance:
- Days 1–60: $0
- Days 61–90: $408/day
- Days 91+: $816/day (for up to 60 lifetime reserve days)
- Days 1–60: $0
📅 When Can One Sign Up
There are several timeframes for enrollment:
Initial Enrollment Period (IEP)
- 7-month window: Begins 3 months before your 65th birthday, includes your birth month, and ends 3 months after.
General Enrollment Period (GEP)
- January 1 – March 31 each year
- Coverage starts July 1 (unless using new rules under certain SEP scenarios)
Special Enrollment Period (SEP)
You may qualify for SEP if you:
- Are still working and covered under a group health plan
- Lost employer coverage recently
- Experienced other qualifying life events
Late Enrollment Penalty: If you miss your initial enrollment and don’t qualify for SEP, you may pay a 10% penalty for twice the number of years you were eligible but didn’t sign up.
🔮 Possible Changes in 2026
Medicare updates every year, and for 2026, here are anticipated or possible changes:
- Cost adjustments:
- Premiums, deductibles, and coinsurance amounts may increase due to inflation and healthcare costs.
- Premiums, deductibles, and coinsurance amounts may increase due to inflation and healthcare costs.
- Legislative reforms:
- Ongoing efforts to lower prescription drug costs (though this mostly affects Part D)
- Potential expansions or tweaks to eligibility or enrollment flexibility based on federal policy
- Ongoing efforts to lower prescription drug costs (though this mostly affects Part D)
- Digital modernization:
- Improved digital tools for enrollment and access to records
- Improved digital tools for enrollment and access to records
- Focus on preventive care:
- Medicare may further emphasize preventive services to lower hospital admissions, potentially affecting how Part A is utilized.
- Medicare may further emphasize preventive services to lower hospital admissions, potentially affecting how Part A is utilized.
🛑 As your local agent, I’ll keep you updated on finalized 2026 changes as they are announced by CMS in late 2025.