Yes, you can have Part B without Part A, but the rules depend on how old you are and your work history

Most people think Medicare Part A and Part B come as a package, but they don't have to. You can enroll in Part B alone — though the path to doing so, and whether it makes financial sense, depends on whether you're 65 or older, whether you worked long enough to earn Part A, and when you first became may be able to access for Medicare.

The key difference: Part A covers hospital stays, skilled nursing, hospice, and home health. Part B covers doctor visits, outpatient care, lab work, and medical equipment. You can decline Part A and keep Part B, but you'll pay out of pocket for any hospital care unless you have another insurance plan covering it.

Key Takeaways

  • You can enroll in Part B alone by declining Part A during your initial enrollment window or during the General Enrollment Period each year from January 1 to March 31.
  • If you worked long enough to earn Part A (usually 40 quarters of Social Security-covered work), Part A is free at 65, so most people take it even if they don't use hospital coverage.
  • If you're still working at 65 and have employer coverage, you can delay both Part A and Part B without penalty as long as your employer plan is active.
  • Declining Part A but taking Part B means you're responsible for all hospital bills unless another insurance covers them, so this choice works best if you have retiree coverage or a spouse's plan.
  • If you decline Part B now, you may face a permanent premium increase (10 percent per year of delay) when you do enroll, unless you have a valid reason for the delay.

When Part A is free and why most people take it anyway

If you or your spouse worked for at least 10 years (40 quarters) under Social Security, you may have access to for premium-free Part A at 65. This means you pay nothing monthly for hospital coverage. Even if you rarely go to the hospital, the cost is zero, so most people enroll.

You still pay a deductible when you use it — $1,676 for the first 60 days of a hospital stay in 2024, though this amount changes yearly. But the monthly premium itself is free. Because of this, declining Part A to save money rarely makes sense unless you have another insurance plan that covers hospital care and you're certain you won't need Medicare's coverage.

If you didn't earn enough work credits for free Part A

If you worked fewer than 10 years under Social Security, you don't may have access to for premium-free Part A. At 65, you can buy Part A with a monthly premium — the amount varies based on how many work credits you have, but it ranges from roughly $275 to $505 per month in 2024. In this case, some people choose Part B alone and skip the paid Part A premium.

This choice makes more sense if you have retiree health coverage from a former employer or if you're on your spouse's health plan and that plan covers hospital stays. Without another plan, you'd be paying Part B premiums and facing the full cost of any hospitalization yourself.

Staying on employer coverage past 65

If you're still working at 65 and your employer has 20 or more employees, your employer's health plan is primary — it pays first. You can delay enrolling in both Part A and Part B without penalty as long as your employer coverage remains active. This is called creditable coverage.

When you do retire and lose that coverage, you have 8 months to enroll in Medicare without a late-enrollment penalty. You can enroll in Part B alone during this window if you want, though most people enroll in both parts at that point. If you miss this 8-month window, you'll face a permanent 10 percent premium increase for Part B for every 12 months you delayed.

How to enroll in Part B without Part A

During your Initial Enrollment Period — the 7-month window centered on your 65th birthday — you can choose to enroll in Part B only. You do this by contacting Social Security, either online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office.

Tell them you want Part B but are declining Part A. They will ask why, and you should have a reason ready: you have retiree coverage, you're on a spouse's plan, or you're still covered by an employer plan. Social Security will document your choice.

If you miss your Initial Enrollment Period, you can enroll during the General Enrollment Period, which runs January 1 through March 31 each year. Coverage starts July 1 of that year. However, if you enroll during General Enrollment and you're past your Initial Enrollment Period, you may face a 10 percent premium increase on Part B for every 12 months you delayed — unless you had a valid reason for the delay, such as active employer coverage.

The cost of Part B without Part A

Part B has a monthly premium that changes yearly. In 2024, the standard premium is $164.90 per month, though higher earners pay more through an income-related adjustment. You also pay a $240 annual deductible and then 20 percent of the cost of most services after that.

Without Part A, you're responsible for 100 percent of hospital costs. A single hospital stay can cost $10,000 to $50,000 or more depending on the reason and length of stay. Unless you have another plan covering hospital care, this is a significant financial risk. Many people who choose Part B alone do so because they have retiree coverage, a spouse's plan, or a Medigap policy that covers Part A costs.

Medigap and Part B without Part A

A Medigap policy is supplemental insurance sold by private insurers that covers some of the costs Medicare doesn't — like deductibles and copays. Some Medigap plans also cover Part A hospital costs if you haven't enrolled in Part A.

However, Medigap insurers can be selective. Some will not sell you a Medigap policy if you've declined Part A, or they may charge more. If you're considering Part B without Part A, contact Medigap insurers directly to ask whether they'll cover you and at what cost. This is an important step before you decline Part A, because Medigap may be your only safety net for hospital bills.

Frequently Asked Questions

What happens if I decline Part A and then have a hospital emergency?

You pay the full bill yourself unless another insurance covers it. A hospital stay can easily cost $10,000 to $50,000 or more. This is why declining Part A only makes sense if you have retiree coverage, a spouse's plan, or a Medigap policy that covers hospital costs.

Can I enroll in Part A later if I change my mind?

Yes. You can enroll in Part A during the General Enrollment Period (January 1 to March 31) each year, with coverage starting July 1. If you enroll outside your Initial Enrollment Period, you may face a 10 percent premium increase for every 12 months you delayed, unless you had a valid reason for the delay.

If I'm still working at 65, do I have to take Part B?

No. If your employer has 20 or more employees and you're actively employed, you can delay both Part A and Part B without penalty. When you retire and lose that coverage, you have 8 months to enroll without a late-enrollment penalty on Part B.

Does declining Part A affect my Part B premium?

No. Your Part B premium is based on your income and enrollment timing, not on whether you have Part A. However, if you delay Part B enrollment past your Initial Enrollment Period without a valid reason, your Part B premium increases by 10 percent for every 12 months of delay.

Can I have Part B and a Medigap policy without Part A?

Some Medigap insurers will sell you a policy that covers Part A costs even if you haven't enrolled in Part A itself. However, not all insurers do this, and some charge more. Contact Medigap insurers directly to ask whether they'll cover you before you decline Part A.