The Basic Rule for Medicare Part A

Medicare Part A covers hospital stays, skilled nursing care, hospice, and home health services. You are may be able to access if you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years. You do not pay a premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working.

If you do not meet the work history requirement, you can still enroll in Part A by paying a monthly premium — currently between $278 and $557, depending on how many quarters of Medicare tax you paid. The exact amount changes each year.

You become may be able to access to enroll in Part A starting three months before the month you turn 65. If you miss that window, you can enroll during the General Enrollment Period (January 1 through March 31 each year), but you may face a permanent 10 percent premium increase for each year you delayed.

Key Takeaways

  • You must be 65 or older, a U.S. citizen or permanent resident with five years of residency, to be may be able to access for Medicare Part A.
  • Part A is free if you or your spouse paid Medicare taxes for at least 10 years; otherwise you pay a monthly premium.
  • You can enroll three months before you turn 65, and missing that window triggers a permanent premium penalty.
  • Some people under 65 — those with end-stage renal disease, ALS, or who have received disability benefits for 24 months — can also enroll in Part A.

Younger People Who May Be may be able to access

You do not have to be 65 to get Medicare Part A. If you have end-stage renal disease (ESRD) — permanent kidney failure requiring dialysis or a transplant — you are may be able to access regardless of age. You can enroll as soon as you start dialysis or receive a transplant.

You are also may be able to access at any age if you have been receiving Social Security Disability Insurance (SSDI) for 24 consecutive months. This means you must have been approved for disability and received payments for two full years before Medicare begins. The 24-month clock starts from the month you first received a disability check, not from the month you applied.

If you have ALS (amyotrophic lateral sclerosis), you do not have to wait 24 months. You become may be able to access for Medicare Part A in the first month you receive an SSDI payment for ALS.

Work History and the 10-Year Rule

The 10-year work history means 40 quarters of Medicare tax contributions. A quarter is roughly three months, so you need approximately 10 years of work where your employer (or you, if self-employed) paid into Medicare. You do not have to have worked all 10 years consecutively — gaps are allowed, and the work can span your entire career.

If you are unsure whether you have 40 quarters, you can check your Social Security record online at ssa.gov or call Social Security at 1-800-772-1213. Your statement shows how many quarters you have earned. If you are short, you may still be able to work a few more years to reach 40 quarters and avoid the premium.

Your spouse's work history counts too. If your spouse has 40 quarters, you can get free Part A at 65 even if you do not have 40 quarters yourself — as long as you are married and at least 62 years old (or any age if you are caring for your spouse's child who is under 16).

Government Employees and Railroad Workers

Most government employees hired after 1983 pay Medicare taxes and earn quarters the same way private-sector workers do. If you were hired before 1983 and paid into a government pension system instead of Social Security, you may not have Medicare tax quarters. You can still enroll in Part A by paying the monthly premium.

Railroad workers who paid into the Railroad Retirement Tax Act (RRTA) system have their railroad service counted toward Medicare may be able to access. The rules are slightly different — you need 10 years of railroad service or 120 months of railroad employment in the last 30 months before age 65. Contact the Railroad Retirement Board at 1-877-772-5772 to verify your may be able to access.

Immigrants and Residency Requirements

You must be a U.S. citizen or a lawful permanent resident (green card holder) to enroll in Medicare Part A. If you are a permanent resident, you must have lived in the United States for at least five consecutive years when ready before you turn 65.

The five-year clock resets if you leave the country for more than 30 days. If you travel outside the U.S. for a month or longer, your residency period starts over. Temporary absences of 30 days or less do not break the clock. If you are unsure whether your time counts, contact Medicare at 1-800-MEDICARE (1-800-633-4227) before you turn 65.

Enrollment Timing and Penalties

Your Initial Enrollment Period (IEP) runs for seven months: 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 on the first day of your birth month (or the first of the following month if you enroll after your birthday).

If you miss your IEP and do not have group health coverage through current employment, you can enroll during the General Enrollment Period (January 1 through March 31). Coverage begins July 1 of that year. You will also owe a 10 percent premium increase for each full 12-month period you were may be able to access but not enrolled — and this penalty is permanent, even if you later drop Part A.

If you are still working and covered by your employer's health plan, you may be able to delay Part A without penalty. You must have current employment-based coverage and be actively working (or be the spouse of someone who is). Once you leave that job or lose the coverage, you have eight months to enroll without penalty.

Special Situations and Exceptions

If you are receiving benefits from the Veterans Administration, you are still may be able to access for Medicare Part A at 65 and should enroll. VA benefits and Medicare Part A work together — they do not replace each other.

If you are in prison or jail, you cannot enroll in Medicare. Your may be able to access is suspended while you are incarcerated. Once you are released, you can enroll during the General Enrollment Period or, if you have a may have access to event (such as loss of group coverage), during a Special Enrollment Period.

If you are living abroad, you can still enroll in Medicare Part A, but coverage for hospital and skilled nursing care outside the United States is very limited. Part A covers emergency care in Canada and Mexico only under specific circumstances. Before moving abroad, contact Medicare to understand what will and will not be covered.

Frequently Asked Questions

Do I have to be a U.S. citizen to get Medicare Part A?

No. Lawful permanent residents (green card holders) are may be able to access if they have lived in the United States for at least five consecutive years. Temporary residents, undocumented immigrants, and visa holders are not may be able to access for Medicare Part A.

What if I worked for 10 years but in different countries?

Only work in the United States counts toward the 40 quarters needed for free Medicare Part A. Work abroad does not count, even if you paid into a similar system. If you do not have 40 U.S. quarters, you can enroll in Part A by paying the monthly premium.

Can I get Medicare Part A if I am still working at 65?

Yes. You are may be able to access to enroll in Part A at 65 regardless of whether you are working. If you have group health coverage through your job, you can delay Part A without penalty, but you are not required to. Enroll during your Initial Enrollment Period to avoid future penalties.

What happens if I turn 65 and do not enroll in Part A?

If you miss your Initial Enrollment Period and do not have group coverage through current employment, you can enroll during the General Enrollment Period (January through March), but coverage does not start until July and you will owe a permanent 10 percent premium increase for each year you delayed.

Can my spouse get free Part A based on my work history?

Yes. If you have 40 quarters of Medicare tax, your spouse can get free Part A at age 65 (or 62 if you are already 62). Your spouse does not need their own work history. You must be married at the time of enrollment.