Most people do not pay a monthly premium for Medicare Part A

Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. If you or your spouse paid Medicare taxes for at least 10 years while working, you get Part A with no monthly premium when you turn 65. You pay nothing each month — the program is already paid for through the payroll taxes you contributed during your working years.

If you did not work long enough to earn Part A for free, you can still get it by paying a monthly premium. The amount depends on how many quarters of Medicare tax you paid. As of 2024, the premium ranges from about $278 to $505 per month, but this figure changes yearly. You would also owe a deductible when you enter the hospital.

Part A is not optional if you are on Social Security or Railroad Retirement benefits at 65 — you are enrolled automatically. If you are not yet on those benefits, you must sign up during your initial enrollment window or face a permanent penalty on your premium.

Key Takeaways

  • You pay no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working.
  • If you did not work long enough, you can buy Part A with a monthly premium that ranges based on your work history.
  • You are automatically enrolled in Part A at 65 if you are receiving Social Security or Railroad Retirement benefits.
  • Part A has a deductible you pay when you are admitted to the hospital, separate from any monthly premium.
  • Delaying enrollment past your initial window can result in a permanent increase to your Part A premium.

Who gets Part A without paying a monthly premium

You do not owe a monthly premium if you have at least 40 quarters of Medicare tax coverage — that is 10 years of work where your employer and you both paid into the Medicare system. You do not have to have worked those 10 years in a row, and you do not have to have worked full-time. Part-time work counts as long as you earned enough in that quarter to be credited.

Your spouse's work history can also may have access to you. If your spouse paid Medicare taxes for 10 years, you can get Part A for free at 65 even if you never worked or worked fewer than 10 years yourself. You must be at least 62 and married to that person, or divorced from them but married for at least 10 years.

If you are a government employee who did not pay Medicare taxes — such as some teachers or civil service workers hired before 1986 — you may not be able to get Part A at all, even by paying a premium. Check with your employer's benefits office about your specific situation.

What you pay if you do not have 10 years of work history

If you have fewer than 10 years of Medicare tax coverage, you can still buy Part A. The monthly premium depends on how many quarters you did pay into the system. If you have 30 to 39 quarters, the premium is lower than if you have fewer than 30 quarters. The exact amount changes each year with inflation.

Even if you buy Part A, you still owe the hospital deductible when you are admitted. As of 2024, that deductible is $1,632 per benefit period, but it increases yearly. A benefit period starts when you enter the hospital and ends 60 days after you leave without being readmitted.

Some people choose not to buy Part A if the premium is high and they are still working and covered by employer insurance. You can delay buying Part A and enroll later without penalty, as long as you sign up during a general enrollment period or a special enrollment period tied to losing other coverage.

Automatic enrollment and what happens if you miss the important date

If you are receiving Social Security or Railroad Retirement benefits when you turn 65, Medicare automatically enrolls you in Part A and Part B. You do not have to do anything. Your coverage starts the first day of the month you turn 65, and your premium (if you have one) is deducted from your benefit check.

If you are not yet on Social Security at 65, you must sign up for Medicare yourself during your initial enrollment window. This window is seven months long: it starts three months before the month you turn 65 and ends three months after. If you miss this window and do not have other may have access to coverage, you pay a permanent 10 percent increase to your Part A premium for twice the number of years you were may be able to access but not enrolled.

For example, if you were may be able to access for three years and did not enroll, you pay a 10 percent penalty for six years. That penalty stays with you for life, even if you enroll later. The only way to avoid it is to enroll during your initial window or during a special enrollment period if you lose other health coverage.

Part A costs beyond the monthly premium

Even if you pay no monthly premium for Part A, you have out-of-pocket costs when you use hospital or skilled nursing services. The hospital deductible applies to each benefit period. If you stay in the hospital more than 60 days in one benefit period, you owe a daily coinsurance amount for days 61 through 90, and a higher daily amount for days 91 through 150.

Skilled nursing facility care is free for the first 20 days of each benefit period if you were hospitalized for at least three days first. From day 21 through day 100, you owe a daily coinsurance amount. After day 100, you pay the full cost yourself.

Home health services covered by Part A have no deductible or coinsurance if the services are ordered by a doctor and you meet the homebound requirement. Hospice care has no deductible, but you may owe small copayments for drugs and respite care.

How to learn about you have 10 years of work history

You can check your work history and Medicare tax credits on your Social Security account at ssa.gov. Create a my Social Security account, sign in, and view your earnings record. The record shows each year you worked and how much you earned. You can also call Social Security at 1-800-772-1213 to ask how many quarters of Medicare coverage you have.

If you see errors on your earnings record, you can correct them through your my Social Security account or by calling Social Security. Corrections can take several months, so start early if you are approaching 65 and want to verify your coverage before enrollment.

If you are self-employed, you may have paid Medicare taxes through self-employment tax on your tax return. Those payments count toward your 10-year requirement the same way employer-paid taxes do.

Part A versus Part B and supplemental coverage

Part A covers hospital and facility care. Part B covers doctor visits, outpatient services, and medical equipment. Part B always has a monthly premium, even if Part A is free. The standard Part B premium for 2024 is $164.90 per month, but it is higher if your income is above certain thresholds.

Many people buy a Medigap policy (supplemental insurance) to cover the deductibles and coinsurance that Part A and Part B leave unpaid. Medigap premiums vary by plan and location but typically range from $100 to $300 per month. Some people choose a Medicare Advantage plan instead, which combines Part A and Part B coverage with an insurance company and often includes prescription drug coverage.

If you have Part A but not Part B, you cannot enroll in a Medigap policy. You must have both Part A and Part B to buy supplemental coverage. This is another reason to enroll in Part B even if you are still working and covered by employer insurance — it keeps your options open for later.

Frequently Asked Questions

Can I get Part A for free if I never worked?

Not on your own work history. However, if you are married to or divorced from someone who worked and paid Medicare taxes for 10 years, you may be able to get Part A for free based on their record. You must be at least 62 and meet the marriage or divorce requirements.

What if I worked in another country?

Work in most countries does not count toward the 10-year requirement unless there is a totalization agreement between the United States and that country. Check with Social Security about your specific situation, as some countries do have agreements that allow you to combine work history.

Do I have to enroll in Part A if I am still working at 65?

If you are covered by your employer's health plan and are still working, you can delay Part B enrollment without penalty. However, if you do not enroll in Part A and later find out you were not may be able to access for free Part A, you may owe a permanent premium penalty. It is safer to enroll in Part A even if you do not use it yet.

What happens to my Part A if I go back to work after 65?

Your Part A coverage does not stop if you return to work. You keep your coverage and your deductibles reset each benefit period. If you are working and have employer insurance, that insurance is primary and Medicare is secondary, meaning your employer plan pays first.

Can I drop Part A if I do not want it?

If Part A is free, you are automatically enrolled at 65 and cannot drop it. If you are paying a premium for Part A, you can choose not to enroll or can drop it later, but you may face a penalty if you enroll again in the future.