Medicare Part A is free for most people at 65, but "free" has limits
If you or your spouse paid Medicare taxes for at least 10 years while working, you will not pay a monthly premium for Medicare Part A when you turn 65. That means hospital insurance, skilled nursing care, hospice, and home health services come with no monthly bill. But Part A is not free in the way people often think — you still pay deductibles and coinsurance when you actually use the services.
The catch is that you must be a U.S. citizen or permanent resident, and you must have worked long enough in a job where your employer and you both paid into the Medicare system. If you do not meet those requirements, you can still buy Part A, but the monthly premium will be substantial — either $278 or $505 per month in 2024, depending on how many years you worked.
You become may be able to access for free Part A the month you turn 65, as long as you have already applied or are receiving Social Security benefits. If you are still working and do not need the coverage yet, you can delay enrollment without penalty, but the rules around that are specific and worth understanding before you decide.
Key Takeaways
- Most people pay no monthly premium for Part A at 65 if they or a spouse paid Medicare taxes for at least 10 years.
- Free Part A still requires you to pay a deductible ($1,632 per hospital stay in 2024) and coinsurance for longer stays.
- You must explore for Medicare or be receiving Social Security benefits to enroll; it does not happen automatically.
- If you do not meet the work requirement, you can buy Part A, but the monthly cost will be $278 or $505 depending on your work history.
What "free" actually means: deductibles and coinsurance you will pay
When Medicare says Part A is free, it means you have no monthly premium — but you will pay money when you use hospital or skilled nursing services. The deductible is the amount you pay out of pocket before Medicare starts paying. For 2024, the Part A deductible is $1,632 per hospital stay. If you are admitted to the hospital twice in the same year, you pay the deductible twice.
After you meet the deductible, Medicare covers most of the cost, but you still pay coinsurance — a daily amount — if you stay longer than a certain number of days. For a hospital stay, you pay nothing for days 1 through 60, then $408 per day for days 61 through 90, then $816 per day for days 91 and beyond (up to 150 days total). For skilled nursing facilities, you pay nothing for the first 20 days, then $204 per day for days 21 through 100.
These numbers change every year, so the amounts you see in 2025 or 2026 will be different. The key point is that free Part A coverage still has real out-of-pocket costs when you need hospital care. Many people buy Medigap (supplemental insurance) or choose a Medicare Advantage plan to reduce these costs, but that is a separate decision from whether Part A itself is free.
Who qualifies for free Part A at 65
You may have access to for free Part A if you are 65 or older and meet one of these conditions: you paid Medicare taxes for at least 10 years (40 quarters) while working, or your spouse did and you are at least 62, or you are a widow or widower and your spouse had 10 years of Medicare tax history. You must also be a U.S. citizen or permanent resident.
If you are not yet receiving Social Security, you still need to sign up for Medicare separately. Social Security does not automatically enroll you at 65 — you have to contact Social Security or go online to Medicare.gov to explore. If you miss the important date, you may face a late enrollment penalty on Part B (the doctor insurance), though Part A itself has no penalty.
If you are still working at 65 and your employer has 20 or more employees, you may be able to delay Part A enrollment without penalty. However, the rules are complex, and delaying the wrong way can cost you. It is worth calling Social Security at 1-800-772-1213 to confirm your situation before you decide to wait.
What happens if you do not meet the 10-year work requirement
If you or your spouse did not pay Medicare taxes for 10 years, you can still buy Part A at 65, but you will pay a monthly premium. For 2024, the premium is $278 per month if you have 30 to 39 quarters of coverage, or $505 per month if you have fewer than 30 quarters. These premiums also change yearly.
You still pay the same deductibles and coinsurance as someone with free Part A — the premium just covers the monthly cost of the insurance itself. Some people in this situation choose to buy Part A anyway because they know they will need hospital care. Others skip it and rely on other coverage or pay out of pocket. That decision depends on your health, your savings, and what other insurance you have.
If you are not a U.S. citizen or permanent resident, you cannot buy Part A at any price. You would need to explore other coverage options through your state or a private insurer.
How to enroll in Part A when you turn 65
You can enroll in Part A online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office. If you are already receiving Social Security benefits, you may be enrolled automatically, but you should verify this by checking your Social Security account online or calling to confirm.
The enrollment window is seven months long: three months before the month you turn 65, the month you turn 65, and three months after. If you enroll during this window, your coverage starts the month you turn 65 (or the first day of that month). If you miss this window and enroll later, your coverage may start the month after you explore, and you could owe a late enrollment penalty on Part B.
You will need your Social Security number, proof of citizenship or permanent residency, and information about any current health coverage. Have these ready before you call or explore online to speed up the process.
Delaying Part A if you are still working
If you are still working at 65 and your employer offers health insurance, you may be able to delay Part A enrollment without losing the free premium. However, this only works if your employer has 20 or more employees. If your employer is smaller, you must enroll in Part A when you turn 65 or you will lose the free premium forever.
Even if you delay Part A, you may still need to enroll in Part B (doctor insurance) depending on your employer's plan. The rules are different for Part A and Part B, so do not assume that delaying one means you can delay the other. Contact Social Security before you turn 65 to understand your specific situation.
If you delay and then leave your job, you have eight months to enroll in Part A without penalty. After that window closes, you will owe the late enrollment penalty for as long as you have Part A.
Part A versus Part B and Part D: what each covers
Part A covers hospital stays, skilled nursing facilities, hospice, and home health services. Part B covers doctor visits, outpatient care, and medical equipment. Part D covers prescription drugs. Part A is free for most people at 65; Part B has a monthly premium (currently $174.70 for most people in 2024, but higher if your income is above a certain level); and Part D premiums vary by plan.
You do not have to take all three. Some people take only Part A and Part B. Others add Part D if they take regular medications. Some people choose a Medicare Advantage plan (Part C) instead, which bundles A, B, and usually D into one plan with different costs and coverage rules.
Understanding what each part covers helps you decide what you actually need. If you rarely see a doctor and take no medications, Part A alone might be enough. If you have chronic conditions, you probably need Part B as well. Part D makes sense if you take prescription drugs regularly.
Frequently Asked Questions
Do I have to enroll in Part A at 65 even if I am still working?
Not if your employer has 20 or more employees and offers health insurance. You can delay without penalty. If your employer is smaller, you must enroll at 65 or lose the free premium. Call Social Security at 1-800-772-1213 to confirm your employer's size and your options before you turn 65.
What if I did not work 10 years but my spouse did?
If your spouse paid Medicare taxes for 10 years, you can get free Part A at 62 (if you are married) or at any age if you are a widow or widower and your spouse had the required work history. You still need to explore separately and meet citizenship requirements.
Can I get Part A without Part B?
Yes. Part A and Part B are separate, and you can enroll in Part A without Part B. However, if you do not enroll in Part B when you are first may be able to access, you may owe a late enrollment penalty later. Talk to Social Security about your situation before you decline Part B.
What if I move to another country after I turn 65?
Part A coverage generally continues if you move abroad, but Part B coverage may be affected. Home health and hospice services may not be covered outside the U.S. Contact Medicare at 1-800-MEDICARE before you move to understand what will and will not be covered in your new location.
Do the deductibles and coinsurance amounts change every year?
Yes. Medicare adjusts Part A deductibles and coinsurance amounts annually based on inflation. The amounts for 2025 will be announced in the fall of 2024. Check Medicare.gov or call 1-800-MEDICARE each year to see the current amounts.