Yes, you can have Part B without Part A, but the rules depend on how old you are and your work history

Medicare Part B (medical insurance) can stand alone without Part A (hospital insurance), but you cannot straightforward skip Part A and keep Part B forever. The path forward depends on whether you are 65 or older, whether you worked long enough to earn Medicare coverage, and whether you are a U.S. citizen or permanent resident.

If you are 65 or older and have worked at least 10 years in jobs where you paid Medicare taxes, you are may have access to to Part A at no monthly cost. You can refuse Part A and take only Part B, paying the Part B premium. If you do not have the work history for free Part A, you can buy Part A and also buy Part B. The key point: Part B exists as a separate purchase, but Part A may be able to access and your choices about it shape what you pay and what coverage you have.

Key Takeaways

  • You can enroll in Part B alone if you are 65 or older, but you cannot avoid Part A penalties unless you have a valid reason to delay it.
  • If you worked 10 years in Medicare-taxed jobs, Part A is free at 65; you can refuse it and take only Part B, but you will pay a higher Part A premium later if you change your mind.
  • If you did not work long enough, you can buy Part A and Part B separately, each with its own monthly cost.
  • Delaying Part B without a valid reason (like employer coverage) triggers a permanent penalty on your premium.

When you can refuse Part A and keep only Part B

If you are 65 or older and may have access to to free Part A because of your work record, you have the right to turn down Part A and enroll in Part B alone. This is a real choice, not a loophole. You pay the Part B premium (which varies by income) and receive doctor visits, outpatient care, and preventive services, but no hospital coverage.

The catch is timing. If you refuse Part A at 65 and later want it, you can enroll during the General Enrollment Period (January 1 to March 31 each year), but you will pay a penalty on your Part A premium for the rest of your life. The penalty is 10 percent for each full year you were may have access to but did not enroll. If you turned down Part A at 65 and enroll at 68, you owe a 30 percent penalty forever. This makes the decision to refuse Part A a permanent one in most cases.

If you do not have 10 years of work history

Not everyone qualifies for free Part A. You need at least 10 years (40 quarters) of work in jobs where you paid Medicare taxes. If you fall short, you can still buy Part A at age 65, but it costs a monthly premium. As of 2024, Part A premiums for people without the full work history range from about $275 to $505 per month, depending on how many quarters you did accumulate.

In this situation, you can buy Part A, Part B, or both. Some people choose Part B only because the Part A premium is high and they have other coverage or believe they will not need hospital care. This is a real option, though it leaves you exposed to hospital bills. Part B alone covers doctor visits and outpatient services but not inpatient hospital stays.

Part B penalties if you delay without a valid reason

Part B has its own enrollment important date separate from Part A. You must enroll in Part B when you turn 65, or during your Initial Enrollment Period (the three months before, the month of, and the three months after your 65th birthday). If you miss this window and do not have a valid reason to delay, you pay a permanent penalty.

A valid reason to delay Part B is employer coverage — if you or your spouse still works and you have health insurance through that job, you can delay Part B without penalty. Once you leave that job or lose the coverage, you have eight months to enroll in Part B without penalty. If you delay for any other reason, your Part B premium increases by 10 percent for each full year you were may have access to but did not enroll. Like the Part A penalty, this increase stays with you for life.

How Part B works without Part A in practice

Part B covers doctor office visits, lab tests, imaging, outpatient surgery, mental health services, and preventive care like screenings and vaccines. You pay a monthly premium (income-based, ranging from about $175 to $560 in 2024), a yearly deductible (currently $240), and 20 percent of the cost of most services after the deductible.

Without Part A, you have no coverage for hospital stays. If you are admitted to a hospital, you pay the full bill out of pocket. This is a significant gap. Many people who choose Part B only add a Medigap policy (supplemental insurance sold by private insurers) to cover some of the costs Part B does not pay. Medigap policies vary in what they cover, but some include hospital deductibles and coinsurance.

Another option is a Medicare Advantage plan (Part C), which combines Part A and Part B coverage through a private insurer. If you enroll in a Medicare Advantage plan, you must have both Part A and Part B, so this route is not available if you want to avoid Part A.

Citizenship and residency requirements

To enroll in Part B (with or without Part A), you must be a U.S. citizen or a permanent resident who has lived in the United States for at least five consecutive years. If you do not meet this requirement, you cannot enroll in Part B at 65, even if you have a work history.

Some people in this situation may have access to state-run programs or other coverage options, but Part B itself is not available to them. Contact your state health department or a local community health center to learn what programs may serve your situation.

Frequently Asked Questions

What happens if I refuse Part A at 65 and never want it later?

You can keep Part B alone for the rest of your life without penalty. You will have doctor coverage but no hospital coverage. If you later change your mind, you can enroll in Part A during the General Enrollment Period, but you will pay a 10 percent penalty for each year you were may have access to but did not enroll.

Can I have Part B without Part A if I am still working?

Yes. If you are working and have employer coverage, you can delay both Part A and Part B without penalty until you leave that job or lose the coverage. Once you do, you have eight months to enroll in Part B without penalty, but Part A has different rules — delaying Part A past 65 triggers a lifetime penalty unless you had employer coverage.

Is Part B alone enough coverage?

Part B covers doctor visits and outpatient care but not hospital stays. Most people add either a Medigap policy (supplemental insurance) or a Medicare Advantage plan (Part C, which includes Part A). Part B alone leaves you exposed to hospital bills, which can be very large.

How much does Part B cost if I do not have Part A?

Part B premiums are based on your income and are the same whether or not you have Part A. In 2024, premiums range from about $175 to $560 per month. You also pay a yearly deductible and 20 percent of covered services. If you buy Part A separately, add its monthly premium on top.

What if I am not a U.S. citizen?

You must be a U.S. citizen or permanent resident living in the United States for at least five consecutive years to enroll in Part B. If you do not meet this requirement, you cannot get Part B through Medicare. Contact your state health department or a local community health center to learn about other options.