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

Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Whether you pay for it depends on how many years you or your spouse paid Medicare taxes during your working life. If you worked at least 40 quarters (10 years) and paid those taxes, you receive Part A at no monthly cost when you turn 65. If you did not work that long, you may still get Part A but will pay a monthly premium.

The amount you pay — if anything — is fixed by Social Security and does not change based on your health or medical history. You will see the charge on your Social Security check or Medicare bill each month. Some people pay nothing. Others pay a reduced premium or the full premium, depending on their work history.

Key Takeaways

  • You pay no Part A premium if you worked at least 40 quarters and paid Medicare taxes, or if your spouse did and you are married.
  • If you worked fewer than 40 quarters, you can still get Part A but will pay a monthly premium that ranges based on how many quarters you worked.
  • Part A also has a deductible you pay when you are admitted to the hospital, separate from any monthly premium.
  • If you delay claiming Social Security past 65, you can still get Part A at no cost, but you must sign up during your enrollment window or face a late penalty.
  • Government employees hired before 1983 may have different rules and should check with their pension office about Part A coverage.

How your work history determines your Part A cost

Social Security tracks the quarters you worked and paid Medicare tax. A quarter is roughly three months; you can earn a maximum of four quarters per year. To get Part A with no premium, you need 40 quarters total — this does not have to be consecutive, and gaps in employment do not erase the quarters you already earned.

If you have fewer than 40 quarters, you will pay a monthly premium. The amount depends on how many quarters you did work. If you worked 30 to 39 quarters, you pay a reduced premium. If you worked fewer than 30 quarters, you pay the full premium. Social Security calculates this automatically when you turn 65 or when you first sign up for Medicare.

If you are married, your spouse's work history counts too. If your spouse worked 40 quarters, you can get Part A at no cost based on their record, even if you did not work that long yourself. This applies whether you are currently married or divorced after at least 10 years of marriage.

Part A deductibles and what you actually pay when you use it

Even if you pay no monthly premium for Part A, you will pay money when you use hospital or skilled nursing services. Part A has a deductible — an amount you pay out of pocket before Medicare starts to pay. For 2024, the Part A deductible is $1,632 per hospital stay. This amount changes each year.

After you meet the deductible, Medicare covers most of your hospital costs for the first 60 days. If you stay longer, you pay a daily amount called coinsurance. For days 61 to 90, you pay a set amount per day. For days 91 and beyond, the costs rise. Skilled nursing facilities work the same way — Medicare covers the first 20 days fully, then you pay coinsurance for days 21 to 100.

These costs are separate from your monthly premium. You might pay no premium but still owe the deductible and coinsurance if you are hospitalized. Many people buy Medigap or Medicare Advantage plans to help cover these out-of-pocket costs.

What happens if you delay Medicare or miss your sign-up window

You become may be able to access for Part A at 65, but you do not have to sign up right away. If you are still working and have health coverage through your job, you can delay. However, if you miss your enrollment window, you may face a late enrollment penalty — a permanent increase to your Part A premium.

The penalty is 10 percent of the full premium amount for each full 12 months you could have had Part A but did not sign up. This penalty stays with you for life, even after you start paying the premium. The only exception is if you had other health coverage (such as employer coverage) when you turned 65; in that case, your enrollment window extends as long as that coverage lasts.

If you are still working at 65 and covered by your employer's plan, tell Medicare. You can request a Special Enrollment Period, which lets you sign up for Part A without the penalty when your work coverage ends.

Government employees and railroad workers: different rules may explore

If you worked for the federal government and were hired before 1983, you may not have paid Medicare tax. These employees were covered under a different system called the Civil Service Retirement System (CSRS). You might still be able to get Part A, but the rules are different, and you may owe a higher premium or have different coverage dates.

Railroad workers who paid into the Railroad Retirement Tax Act also have separate rules. If this applies to you, contact your pension office or the Railroad Retirement Board before you turn 65. They can tell you whether you owe a Part A premium and when your coverage begins.

How to find out what you will pay

You can check your work history and estimated Part A cost through your personal Social Security account at ssa.gov. Log in, go to "Earnings Record," and review the quarters listed. If the record looks wrong, you can request a correction, though this can take time.

You can also call Social Security at 1-800-772-1213 and ask them to review your record and tell you whether you will pay a Part A premium. Have your Social Security number ready. They will tell you the exact amount you will owe starting at 65.

About three months before you turn 65, Medicare will mail you a notice showing your Part A coverage and any premium amount. Review it carefully. If it looks wrong, contact Social Security or Medicare right away to correct it before your coverage starts.

Frequently Asked Questions

Can I get Part A for free if I never worked?

No. If you never worked or worked fewer than 40 quarters, you will pay the full monthly premium for Part A. However, you can still sign up at 65. Some people in this situation choose to skip Part A and use a Medicare Advantage plan instead, though this is not usually recommended.

What if I worked in another country?

Work outside the United States generally does not count toward your 40 quarters unless you paid U.S. Medicare tax. However, some countries have agreements with the U.S. that allow certain work to count. Contact Social Security to ask whether your foreign work history qualifies.

Do I have to pay Part A premium if I am on disability?

No. If you receive Social Security Disability Insurance (SSDI) and have been on it for 24 months, you automatically get Medicare Part A at no cost when you turn 65. Your disability coverage converts to regular retirement coverage, but the premium remains zero.

What if my spouse worked but I did not — can I get Part A free?

Yes. If you are married to someone who worked 40 quarters, you can get Part A at no cost based on their record. This also applies if you are divorced and were married for at least 10 years to someone who worked 40 quarters.

Does Part A premium go up every year?

The full Part A premium amount changes each year, but only if you are paying one. If you pay no premium because you worked 40 quarters, your cost stays zero. If you pay a reduced or full premium, the amount may increase annually based on Social Security's cost-of-living adjustment.