The Center for Medicare Advocacy was recently successful in advocating for a beneficiary’s Part A premium elimination, saving the beneficiary thousands of dollars in reimbursed premiums and a significantly reduced burden in healthcare costs into the future.
Most people who qualify for Medicare do not pay a premium for Part A, which provides coverage for hospital, skilled nursing, and other inpatient services. Entitlement to premium-free Part A is generally based on an individual’s work history and payment of Social Security taxes (or that of their spouse other family member, in some cases). Those who do not have at least 40 work quarters credited by the Social Security Administration (SSA) usually have to pay a hefty premium for Part A, ranging from $285-$518 per month in 2025.
However, certain public retirees who have at least 30 work quarters credited by SSA may qualify for a premium reduction or elimination. This generally applies to former state or municipal employees, such as teachers, who have paid into a separate retirement system for most of their careers rather than paying taxes for Social Security retirement benefits.
A Connecticut beneficiary who qualified for the premium elimination under this rule contacted CMA for assistance after several unsuccessful attempts at applying for the premium elimination through SSA. CMA worked together with Congressman John Larson’s office to advocate for the beneficiary’s premium elimination, writing a letter on her behalf outlining her qualifications for each of the rule’s provisions. SSA agreed, refunding the beneficiary nearly $4,000 in overpaid premiums, and eliminating her Part A premium liability going forward.
For more information on this rule, see subsection 5.b of 42 USC §1395i–2 and POMS HI 00801.135 (HI Premium Reduction to Zero for Certain Public Retirees)
July 10, 2025 – M. Lambert