Most people do not pay a monthly premium for Medicare Part A if they or their spouse paid Medicare taxes while working

Medicare Part A covers hospital stays, skilled nursing care, hospice, and home health services. Whether you pay for it depends on how many years you or your spouse worked and paid Medicare taxes — not on your age or income.

If you worked at least 10 years (40 quarters) in a job where you paid Medicare taxes, you get Part A with no monthly premium. If you worked fewer than 10 years, you can still buy Part A, but you will pay a premium that ranges based on how many quarters you worked. The Social Security Administration keeps the record of your work history and tax payments, so they determine whether you owe a premium.

You become may be able to access for Part A at 65, or earlier if you have been on Social Security disability for 24 months or have end-stage renal disease or ALS. Enrollment happens automatically if you are already receiving Social Security benefits; if not, you must sign up during your initial enrollment period or face a late penalty.

Key Takeaways

  • You pay no Part A premium if you or your spouse worked at least 10 years in a job covered by Medicare taxes.
  • If you worked fewer than 10 years, you can buy Part A, but the monthly premium depends on how many quarters of work you have on record.
  • Social Security holds your work history and determines your premium status; you cannot appeal their calculation, but you can request a review if you believe your record is wrong.
  • Part A still has costs even if the premium is free: you pay a deductible for hospital stays and coinsurance for longer stays or skilled nursing care.
  • If you miss your initial enrollment window and do not have a may have access to reason, you pay a 10 percent premium increase for as long as you have Part A.

How work history determines whether you pay a premium

The threshold is 40 quarters of work — roughly 10 years of full-time employment. A quarter is three months. If you worked part-time or had gaps, you may still have 40 quarters if you worked long enough overall. Social Security counts only the quarters where you earned enough to be credited; in 2024, you need $1,730 in earnings in a quarter for it to count, but that amount changes yearly.

If you are married, your spouse's work history counts too. If your spouse has 40 quarters but you do not, you can get Part A with no premium based on their record. The same applies if you are divorced and were married at least 10 years — you can use your ex-spouse's work history even if they have already claimed benefits.

If you have fewer than 40 quarters, Social Security will tell you how many you have and calculate your premium. The premium for someone with 30 quarters is lower than for someone with 20 quarters. You can view your work record online through your Social Security account or request a paper statement by mail.

Part A premiums and costs if you do not have 40 quarters

If you worked fewer than 10 years, you can still buy Part A starting at 65. The monthly premium in 2024 is $278 if you have 30 to 39 quarters of work, or $505 if you have fewer than 30 quarters. These amounts change each year. You pay this premium for as long as you have Part A.

Some people choose not to buy Part A if the premium is high and they do not expect to use hospital services. That is a choice you can make, but if you change your mind later, you can only enroll during the general enrollment period (January 1 to March 31 each year), and you will pay a 10 percent premium increase for twice as many years as you delayed.

Even if you pay no premium, Part A has other costs. You pay a deductible ($1,632 in 2024) for each hospital stay. If you stay longer than 60 days, you pay coinsurance ($408 per day in 2024 for days 61 to 90). Skilled nursing care has its own coinsurance after the first 20 days. These amounts change yearly.

When you must enroll and what happens if you miss the important date

Your initial enrollment period is the three months before the month you turn 65, the month itself, and the three months after. If you miss this window and do not have a may have access to reason, you pay a 10 percent premium increase for twice as many years as you delayed. If you delayed for three years, you pay 30 percent more for life.

If you are still working at 65 and have health coverage through your employer, you may have a special enrollment period that lets you sign up later without penalty. You must tell Social Security about your work status; do not assume they know. The same applies if you are covered under your spouse's employer plan.

If you are already receiving Social Security benefits when you turn 65, Medicare Part A and Part B enroll automatically. You will receive your Medicare card in the mail about three months before your 65th birthday. If you do not want Part B (the doctor and outpatient coverage), you must decline it in writing; Part A will stay active.

How to check your work record and request changes

You can view your Social Security work record online at ssa.gov by creating an account. The record shows the quarters you have been credited with and your estimated benefits. If you see an error — a year where you worked but no earnings are listed, or earnings that seem too low — you can request a correction.

You have a limited time to correct old records. Generally, you can correct earnings from the past three years, three months, and 15 days. For older years, you need documents like tax returns or W-2s to prove the error. Contact Social Security by phone at 1-800-772-1213 or visit a local office with your documents.

If your record is correct but you believe you should have more quarters because you worked in a job not normally covered by Medicare (such as government employment with a pension), you may have a different situation. Some government workers are covered under different rules. Social Security can explain your specific case.

Part A costs beyond the premium

Part A covers the bulk of hospital costs, but you pay the deductible upfront and coinsurance for longer stays. The deductible applies once per benefit period, not once per year. A benefit period starts when you enter the hospital and ends 60 days after you leave without being readmitted.

If you are admitted again within 60 days, it counts as the same benefit period and you do not pay another deductible. If you are readmitted after 60 days, a new benefit period begins and you owe a new deductible. Skilled nursing care is covered only if you were hospitalized for at least three days first, and only for up to 100 days per benefit period.

Home health services are covered with no deductible or coinsurance if you are homebound and a doctor orders the care. Hospice is covered with no deductible, though you may pay small copayments for drugs and respite care. Understanding these costs helps you plan for out-of-pocket expenses even when your premium is free.

Frequently Asked Questions

Can I get Part A without paying a premium if my spouse worked but I did not?

Yes. If your spouse has 40 quarters of work, you can get Part A with no premium based on their record. This applies whether you are currently married or divorced, as long as you were married for at least 10 years.

What if I worked in another country — does that count toward the 40 quarters?

Work in most countries does not count toward Medicare quarters. However, some countries have agreements with the United States that allow work to be credited. Contact Social Security to ask whether your foreign work history qualifies.

If I delay enrolling in Part A, can I avoid the penalty later?

Only if you have a may have access to reason, such as employer coverage or government employment. If you delay without a may have access to reason, the 10 percent penalty is permanent. You cannot remove it even after you finally enroll.

Do I have to take Part A if I do not want hospital coverage?

If you have no premium, you can decline Part A, but you cannot get it back later without paying a penalty. If you have a premium, you can choose not to buy it, but the same penalty applies if you change your mind.

How often do Part A premiums and deductibles change?

Medicare adjusts premiums and deductibles each year based on inflation and program costs. Social Security announces the new amounts in October for the following year. Check your Social Security statement or Medicare.gov in the fall to see what your costs will be.