Medicare Part A is free for most people over 65, but not everyone

If you or your spouse paid Medicare taxes while working, you will not pay a monthly premium for Medicare Part A (hospital insurance) when you turn 65. You may still owe a deductible when you use it, but the insurance itself costs nothing each month.

If you did not pay enough Medicare taxes during your working years, you can still get Part A — but you will pay a monthly premium. The amount depends on how many quarters of Medicare tax you paid. Some people pay around $278 per month; others pay more. The exact amount changes each year.

Part A covers hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. It does not cover doctor visits or outpatient care — that is what Part B does.

Key Takeaways

  • You get free Part A at 65 if you or your spouse paid Medicare taxes for at least 10 years (40 quarters) while working.
  • If you paid fewer than 10 years of Medicare taxes, you can still enroll in Part A but will pay a monthly premium.
  • Free Part A still has a deductible when you use hospital services, so "free" means no monthly cost, not no out-of-pocket cost.
  • You must enroll in Part A when you turn 65, even if you are still working, unless you have employer coverage that meets certain rules.

Who gets Part A without paying a monthly premium

You may have access to for premium-free Part A if you have earned at least 40 quarters of Medicare tax credit. A quarter is roughly three months of work; most people earn four quarters per year. That means 40 quarters is about 10 years of work where Medicare taxes were taken from your paycheck.

Your spouse's work history counts too. If your spouse paid enough Medicare taxes, you can get premium-free Part A based on their record, even if you did not work or worked fewer years. You do not have to be married now — if you are divorced and were married for at least 10 years, your ex-spouse's work record may count.

If you are not a U.S. citizen, you still may have access to for premium-free Part A if you meet the work requirement and have been a permanent resident for at least five years.

What you pay if you do not have 40 quarters of work

If you have 30 to 39 quarters of Medicare tax credit, you pay a reduced monthly premium — currently around $278 per month, though this amount changes yearly. If you have fewer than 30 quarters, the premium is higher, currently around $506 per month.

These amounts are set by Medicare each October and take effect the following January. You can find the current premium amounts on Medicare.gov or by calling 1-800-MEDICARE.

Even if you pay a premium for Part A, you still owe the hospital deductible when you use it. In 2024, that deductible is $1,632 for each benefit period. A benefit period starts when you enter the hospital and ends 60 days after you leave without receiving inpatient care.

Part A deductibles and costs you will still owe

Premium-free Part A does not mean free hospital care. You will owe an inpatient deductible the first time you use hospital services in each benefit period. After you meet the deductible, Medicare covers all hospital costs for days 1 through 60 of your stay.

For days 61 through 90, you owe a daily coinsurance amount — currently $408 per day. If you stay longer than 90 days, you can use lifetime reserve days, which Medicare provides once in your lifetime. You pay $816 per day for those days.

Skilled nursing facility care has its own rules. Medicare covers the first 20 days fully after a hospital stay of at least three days. Days 21 through 100 require a daily coinsurance payment, currently $204 per day. After day 100, you pay all costs.

When you must enroll in Part A

You should enroll in Part A when you turn 65, even if you do not plan to retire right away. If you miss the enrollment window and do not have employer coverage that meets Medicare's rules, you may pay a late enrollment penalty for as long as you have Part A.

The penalty is 10 percent of the Part A premium for twice the number of years you delayed enrollment. If you waited three years to enroll, you would pay a 60 percent penalty on top of your regular premium — permanently.

You can enroll in Part A during your Initial Enrollment Period, which is the three months before the month you turn 65, the month you turn 65, and the three months after. If you are still working and have employer coverage, you may be able to delay enrollment without penalty, but you need to check with your employer's benefits office first.

How to learn about you may have access to for premium-free Part A

You can check your Medicare tax record by creating an account on ssa.gov and viewing your Social Security Statement. This shows your earnings history and the number of quarters you have earned.

You can also call Social Security at 1-800-772-1213 to ask how many quarters you have. Have your Social Security number ready.

When you are ready to enroll in Medicare, you can do so online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. You will need your Social Security number and proof of citizenship or permanent residency.

Part A versus Part B and other coverage options

Part A covers hospital and facility care. Part B covers doctor visits, outpatient services, and medical equipment — and it does have a monthly premium for everyone, currently around $175 per month for most people in 2024. You enroll in Part B at the same time as Part A.

Some people choose Medicare Advantage (Part C) instead of Original Medicare (Part A and B). Advantage plans are run by private insurance companies and often have lower or no premiums, but they have different deductibles, copays, and provider networks. You still need Part A and Part B to enroll in an Advantage plan.

If you have retiree health coverage from a former employer, check with that plan before enrolling in Medicare. Some employer plans coordinate with Medicare, and enrolling in the wrong order can cost you money.

Frequently Asked Questions

Do I have to pay for Part A if I never worked?

If you never worked or did not pay Medicare taxes, you cannot get Part A based on your own record. However, if you are married or were married for at least 10 years, you may may have access to based on your spouse's work history. If neither applies, you would need to purchase Part A with a premium.

What happens if I enroll in Part A late?

You will owe a late enrollment penalty equal to 10 percent of the Part A premium for twice the number of years you delayed. This penalty stays with you for as long as you have Part A. The only exception is if you had employer coverage that met Medicare's rules when you first became may be able to access.

Can I have Part A without Part B?

Yes. You can enroll in Part A alone and delay Part B if you are still working and have employer coverage. However, if you delay Part B after you leave your job, you will owe a late enrollment penalty on Part B premiums. Talk to your employer's benefits office about your options before you turn 65.

Does Part A cover nursing home care?

Part A covers skilled nursing facility care for up to 100 days after a hospital stay of at least three days. It does not cover long-term custodial care in a nursing home. If you need ongoing care that is not skilled nursing, you or your family would pay out of pocket or use Medicaid if you may have access to.

Will my Part A premium go up each year?

Yes. Medicare sets new Part A premiums and deductibles each October, and they take effect January 1. The amounts change based on healthcare costs and other factors. You can check Medicare.gov each fall to see the new amounts for the coming year.