Most people don't pay a monthly premium for Medicare Part A

If you or your spouse paid Medicare taxes for at least 10 years while working, you won't owe a monthly premium for Part A hospital insurance. You become covered automatically at age 65 if you're already receiving Social Security benefits, or you can sign up during your initial enrollment period if you're not yet taking benefits.

The phrase "free Part A" is common, but it's more accurate to say you've already paid for it through payroll taxes during your working years. You still pay other costs when you use hospital services—deductibles, copayments, and coinsurance—but the monthly premium itself is zero.

If you didn't work long enough to may have access to for premium-free Part A, you can still buy it. The monthly premium in 2024 ranges from about $278 to $505 depending on how many quarters of Medicare tax you paid. These amounts change each year.

Key Takeaways

  • You pay no monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while employed.
  • If you don't meet the 10-year requirement, you can purchase Part A coverage, though the monthly cost varies based on your work history.
  • Even with premium-free Part A, you pay a deductible when you're admitted to the hospital and copayments for extended stays.
  • You're automatically enrolled in Part A at 65 if you're receiving Social Security, but you must sign up separately if you're still working.

How the 10-year work requirement works

Medicare counts "quarters of coverage," not consecutive years. A quarter of coverage is earned when you pay Medicare taxes on at least $1,550 of wages in a three-month period (this threshold changes yearly). You need 40 quarters total, which adds up to roughly 10 years of work, but those years don't have to be recent or unbroken.

If you worked for 15 years, took 5 years off, then worked another 2 years, you'd still may have access to for premium-free Part A because you have more than 40 quarters. The IRS tracks this through your Social Security record, so your work history is already on file.

Spouses can also may have access to based on their partner's work record. If your spouse paid Medicare taxes for 10 years, you can get premium-free Part A at 65 even if you never worked or worked fewer than 10 years yourself. You must be at least 62 and married for at least one year.

What you pay if you don't may have access to for premium-free Part A

If you have fewer than 30 quarters of coverage, the monthly premium is higher—roughly $505 in 2024. If you have between 30 and 39 quarters, the premium is lower but still required, around $278 to $505 depending on exactly how many quarters you have. These amounts are adjusted annually.

You can buy Part A coverage at any time, but if you delay signing up past your initial enrollment period and don't have a valid reason, you may face a permanent 10 percent premium increase. Your initial enrollment period is the seven-month window that includes the three months before you turn 65, the month you turn 65, and the three months after.

Some people who are still working at 65 can delay Part A enrollment without penalty if they have health coverage through their employer. This is called the "working exception," and it applies if your employer has 20 or more employees and you're actively employed.

Costs you pay even with premium-free Part A

Premium-free doesn't mean cost-free. When you're admitted to a hospital, you pay a deductible—$1,632 per benefit period in 2024. A benefit period starts when you're admitted and ends 60 days after you're discharged with no hospital stays in between.

If you stay longer than 60 days, you pay coinsurance: roughly $408 per day for days 61 through 90, and $816 per day for days 91 through 150. After 150 days, you pay the full cost of your hospital stay. These amounts change yearly.

Skilled nursing facility care, home health services, and hospice also have their own cost structures under Part A. You pay nothing for home health or hospice if you meet the conditions, but skilled nursing has a coinsurance amount after the first 20 days.

When you're automatically enrolled versus when you must sign up

If you're already receiving Social Security retirement or disability benefits when you turn 65, Medicare Part A and Part B are enrolled automatically. You'll receive a Medicare card in the mail about three months before your 65th birthday. You don't have to do anything.

If you're still working and haven't claimed Social Security, you must sign up for Part A yourself during your initial enrollment period. You can do this online through Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Missing this window can result in a permanent premium penalty if you later need to buy Part A.

Railroad workers covered under the Railroad Retirement Act have a separate process. They should contact the Railroad Retirement Board rather than Social Security to enroll in Medicare.

Part A and other coverage you might have

If you have health coverage through your current employer, you can delay Part A enrollment without penalty as long as you're actively employed and the employer has at least 20 employees. Once you leave that job or lose the coverage, you have eight months to sign up for Part A without facing a late penalty.

If you have COBRA coverage from a former employer, it doesn't count as current employer coverage for this purpose. You should still enroll in Part A during your initial enrollment period to avoid penalties.

Veterans with VA health benefits can have both VA coverage and Medicare Part A. They don't conflict, and you're not required to choose one over the other. Some people use VA for certain services and Medicare for others.

Frequently Asked Questions

What happens if I turn 65 and don't sign up for Part A?

If you're not automatically enrolled through Social Security and you miss your initial enrollment period, you can still buy Part A later. However, you'll face a permanent 10 percent premium increase for twice the number of years you were may be able to access but not enrolled. If you were may be able to access for two years and didn't sign up, you'll pay 20 percent more forever.

Can I get premium-free Part A if I'm self-employed?

Yes, if you paid self-employment tax for at least 10 years. Self-employment tax counts toward Medicare coverage the same way payroll tax does. The Social Security Administration tracks this automatically through your tax returns.

Do I have to take Part A if I have other insurance?

You're not required to take Part A, but if you delay past your initial enrollment period without a valid reason like current employer coverage, you'll face a permanent premium penalty when you do enroll. If you have retiree health coverage from a former employer, that usually counts as a valid reason to delay.

What if I worked outside the United States?

Work performed in the United States counts toward Medicare coverage. Work outside the U.S. generally does not, even if you paid U.S. taxes. Some countries have agreements with the U.S. that allow certain work to count, so contact Social Security if you worked abroad and want to verify your record.

Can I change my mind about Part A after I enroll?

If you enrolled in Part A and Part B together, you can drop Part B but not Part A—Part A enrollment is permanent once it starts. If you enrolled in Part A only and haven't started Part B, you can unenroll from Part A, but you'll face a permanent premium increase if you enroll again later.