Numerous older adults and people with disabilities are eligible for Medicare Parts A (hospital care) and B (physician services) but cannot afford their premiums and other costs because of limited income. In particular, older adults who qualify to enroll in Medicare but who lack ample work history with the Social Security Administration (SSA) must pay hefty monthly premiums to enroll in Medicare Part A (up to $450 per month in 2011). In 2005, 1.6 million older adults (5 percent) in the United States and 189,000 older New Yorkers (8 percent) failed to qualify for premium-free Part A. Persons with no or limited Social Security work credits include individuals who work outside of the Social Security payroll tax system, people who hold jobs as domestics, for example, or as restaurant, seasonal or construction workers, as well as recent immigrants for whom English is not their first language. Because these individuals often hold low-wage jobs and do not qualify for Social Security retirement benefits, they often have incomes too limited to afford to enroll in Medicare.