Medicare Part A is free for most people at 65

Medicare Part A — hospital insurance — costs nothing if you or your spouse paid Medicare taxes while working. You do not pay a monthly premium. When you turn 65, Part A covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services.

You become may have access to to Part A automatically at 65 if you are already receiving Social Security retirement or disability benefits. If you are not yet receiving benefits, you must contact Social Security to enroll. There is no process process beyond that — the coverage begins the month you turn 65.

Part A does have cost-sharing: you pay a deductible for each hospital stay (the amount changes yearly) and daily coinsurance if you stay longer than a certain number of days. But the insurance itself — the monthly premium — is free.

Key Takeaways

  • Part A hospital insurance is free at 65 if you paid Medicare taxes for at least 10 years while working.
  • You do not pay a monthly premium for Part A, though you will pay a deductible and coinsurance when you use hospital services.
  • Part A covers inpatient hospital stays, skilled nursing care after hospitalization, hospice, and some home health visits.
  • If you do not have 10 years of work history, you may still get Part A by paying a monthly premium, which varies by your work record.
  • Enrollment in Part A happens automatically through Social Security if you are already receiving benefits at 65.

Who gets Part A for free

You get free Part A if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters). The work does not have to be recent — it counts if you paid taxes decades ago. You must be 65 or older, a U.S. citizen or permanent resident, and a resident of the United States.

If your spouse worked long enough but you did not, you can still get free Part A based on their work record. The same applies if you are divorced — your ex-spouse's work record counts if you were married at least 10 years and are now 62 or older.

If you worked fewer than 10 years, you do not get Part A for free. You can still enroll and pay a monthly premium instead. The premium amount depends on how many quarters of work you have — someone with 30 quarters pays less than someone with zero quarters.

What Part A actually covers

Part A pays for a hospital bed, meals, and nursing care during an inpatient hospital stay. It covers the first 60 days fully (after you pay the deductible), then charges you coinsurance for days 61 through 90. If you stay longer than 90 days, you can use "lifetime reserve days" — a limited pool of extra days Medicare will cover at a higher coinsurance rate.

Part A also covers skilled nursing facility care, but only if you were hospitalized first and your doctor orders the transfer. It does not cover custodial care — help with bathing, dressing, or meals — unless it is part of skilled nursing treatment. Hospice care is covered in full when you choose hospice instead of curative treatment for a terminal illness.

Home health services are covered when ordered by your doctor and provided by a Medicare-certified agency. This includes nursing visits, physical therapy, and occupational therapy, but not housekeeping or meal delivery.

Part B and Part D are not free

Medicare Part B — medical insurance for doctor visits, outpatient care, and preventive services — requires a monthly premium. The standard premium in 2024 is $164.90 per month, though it changes yearly and is higher for people with larger incomes. Part B also has a deductible and coinsurance.

Medicare Part D — prescription drug coverage — is optional and comes from private insurance companies, not Medicare directly. Each plan has its own monthly premium, deductible, and cost-sharing. You choose a plan during enrollment, and the premium varies widely depending on which drugs you take and which plan you pick.

Part B is not automatic — you must enroll during your initial enrollment period (the three months before and after you turn 65) or pay a penalty if you enroll later. Part D enrollment also has important date, and missing them can result in a permanent penalty.

Medigap and Medicare Advantage are separate from free Part A

Medigap (supplemental insurance) is optional and purchased from private insurers. It helps pay the deductibles, coinsurance, and copayments that Part A and Part B leave you responsible for. Medigap has its own monthly premium.

Medicare Advantage (Part C) is an alternative to Original Medicare (Parts A and B). It is offered by private insurance companies and bundles Part A, Part B, and usually Part D into one plan. If you choose Medicare Advantage, you still get Part A coverage, but through the private plan rather than directly from Medicare. Medicare Advantage plans have monthly premiums, deductibles, and copayments that vary by plan.

You cannot have both Original Medicare and Medicare Advantage at the same time. If you have free Part A through Original Medicare and want to switch to Medicare Advantage, you will be covered through the Advantage plan instead, though you may pay a premium.

When to enroll in Part A

You should enroll in Part A during your initial enrollment period — the three months before the month you turn 65, the month you turn 65, and the three months after. If you are already receiving Social Security benefits, enrollment happens automatically and you do not need to do anything.

If you are not receiving Social Security, contact Social Security directly to enroll in Part A. You can call 1-800-772-1213, visit your local Social Security office, or go online to ssa.gov. Have your birth certificate, proof of citizenship or permanent residency, and proof of residence ready.

If you miss your initial enrollment period and do not have a valid reason, you may face a permanent penalty on your Part A premium (if you ever need to pay one). The penalty is 10 percent of the standard premium for each full year you were may be able to access but not enrolled.

Frequently Asked Questions

Do I have to pay anything for Part A if I worked long enough?

No monthly premium, but yes to other costs. You pay a deductible when you are hospitalized and coinsurance for longer stays. These are one-time costs per hospital stay, not monthly bills. The deductible amount changes yearly — in 2024 it is $1,632 per hospital stay.

What if I worked in another country — does that count toward the 10 years?

Work in most countries does count if you paid into a Social Security-type system there. Social Security has agreements with many countries to count those quarters. Contact Social Security to verify whether your foreign work history qualifies.

Can I get Part A if I am under 65?

Yes, if you have received Social Security disability benefits for 24 months or have end-stage renal disease or ALS. You become may have access to to Part A automatically when you meet these conditions, regardless of age. Otherwise, you must wait until 65.

If Part A is free, why do some people say they pay for Medicare?

They are paying for Part B (doctor visits) and Part D (prescriptions), which are not free. Part A itself has no monthly premium, but the deductibles and coinsurance when you use hospital services are real costs that add up.

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

Your Part A coverage does not change. Once you are enrolled, you keep it regardless of whether you work. Working does not affect your Part A benefits or premium.