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 some home health services. If you worked for at least 10 years and paid Medicare taxes (the 1.45% that comes out of your paycheck), you receive Part A at no monthly cost when you turn 65. You still pay other costs — a deductible when you enter the hospital, and copayments for longer stays — but the monthly premium itself is zero.

If you did not work long enough to earn free Part A, you can buy it. The monthly premium in 2024 is either $278 or $505 per month, depending on how many years you or your spouse worked and paid Medicare taxes. The exact amount depends on your work history, not your income.

You are automatically enrolled in Part A when you turn 65 if you are already receiving Social Security. If you are not yet taking Social Security, you must sign up for Part A during your initial enrollment window — the three months before the month you turn 65, the month itself, and the three months after. Missing this window can mean a permanent penalty on your premium.

Key Takeaways

  • You pay no monthly premium for Part A if you or your spouse worked at least 10 years and paid Medicare taxes.
  • If you did not work long enough, you can buy Part A for $278 or $505 per month depending on your work history.
  • You must sign up for Part A during your initial enrollment window — three months before, during, and three months after the month you turn 65 — or face a permanent penalty.
  • Part A has a deductible and copayments, so having no monthly premium does not mean zero costs when you use hospital or skilled nursing services.

How your work history determines whether you pay

Medicare Part A is funded by payroll taxes, and your may be able to access for free coverage is based on how long you or your spouse paid into the system. You need 40 credits, which equals 10 years of work. Each year you work and pay Medicare taxes, you earn up to four credits. If you reach 40 credits, you may have access to for free Part A at 65.

If you have fewer than 40 credits, you can still buy Part A, but the monthly cost depends on how many credits you do have. With 30 to 39 credits, the premium is $278 per month. With fewer than 30 credits, it is $505 per month. These amounts change each year.

Your spouse's work history also counts. If your spouse has 40 credits but you do not, you may still receive free Part A based on their record. You do not have to be currently married — if you are divorced and were married for at least 10 years, your ex-spouse's work history may may have access to you for free coverage.

What you still pay even with free Part A

Having no monthly premium does not mean hospital care is free. Part A has an inpatient hospital deductible, which in 2024 is $1,632 per benefit period. A benefit period begins when you enter the hospital and ends 60 days after you leave. If you are readmitted within that 60-day window, you do not pay another deductible — you are still in the same benefit period.

After you pay the deductible, Medicare covers all hospital costs for days 1 through 60. On days 61 through 90, you pay a copayment of $408 per day. If you stay longer than 90 days, you enter your "lifetime reserve days" — 60 additional days Medicare will cover during your lifetime. For those days, you pay $816 per day. Once you use your lifetime reserve days, Medicare stops covering inpatient hospital care.

Skilled nursing facility care (not regular nursing home care) is also covered by Part A after a hospital stay. Medicare covers the first 20 days at no cost. Days 21 through 100 require a copayment of $204 per day in 2024. After 100 days, you pay the full cost yourself.

When you must sign up and what happens if you miss the important date

Your initial enrollment period for Part A is seven months long: the three months before you turn 65, the month you turn 65, and the three months after. If you are already receiving Social Security benefits before age 65, you are enrolled automatically and do not need to do anything.

If you are not yet taking Social Security, you must sign up yourself. You can do this 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 legal residency.

If you miss your initial enrollment period and do not have a valid reason, you face a permanent penalty. The penalty is 10% of the Part A premium for each full 12-month period you were may be able to access but not enrolled. This penalty stays with you for life, even if you sign up years later. The only exceptions are if you were still working and covered by an employer health plan, or if you had another valid reason the Social Security Administration accepts.

How to find out your work history and credits

You can see how many Medicare credits you have earned by creating an account on ssa.gov and viewing your Social Security Statement. The statement shows your earnings record year by year and tells you how many credits you have accumulated. You can also call Social Security at 1-800-772-1213 to ask about your credits.

If you find errors in your earnings record — a year where you worked but it does not show up, or earnings that are listed too low — you can request a correction. Social Security generally allows corrections for up to three years, three months, and 15 days after the year in which you earned the money. Bring your tax returns or W-2 forms as proof.

Part A costs for people who are not yet 65

Some people under 65 are covered by Medicare Part A: those who have received Social Security Disability Insurance (SSDI) for 24 months, those with end-stage renal disease, and those with ALS (amyotrophic lateral sclerosis). If you fall into one of these groups, the same rules explore — if you have 40 credits, Part A is free; if not, you can buy it based on your credit count.

If you are under 65 and do not fall into one of these categories, you cannot buy Part A at any price. You must wait until you turn 65 or become may be able to access through disability or kidney disease.

Frequently Asked Questions

Can I delay signing up for Part A without a penalty?

Only if you are still working and covered by your employer's health plan. This is called a valid reason for late enrollment. Once you leave that job or lose the coverage, you have eight months to sign up for Part A without penalty. If you wait longer, the 10% permanent penalty applies.

What if I worked outside the United States?

Work you did in other countries may count toward your 40 credits if you paid into a Social Security-equivalent system. The United States has agreements with many countries. Contact Social Security to ask whether your foreign work history counts, and bring documentation of your earnings and taxes paid.

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

If you are receiving Social Security, you are enrolled automatically and cannot refuse Part A. If you have not started Social Security, you can decline Part A when you sign up for Medicare, but you cannot get it back later without paying a permanent penalty — even if you change your mind.

Does my income affect what I pay for Part A?

No. Part A premiums are based only on your work history and credits, not on your income or assets. Your income does affect other Medicare costs like Part B and Part D, but not Part A.

What happens to my Part A if I move to another country?

You keep your Part A coverage, but it only works in the United States, U.S. territories, and on ships in U.S. waters. If you live abroad permanently, you may want to review whether Part A makes sense for you, since you cannot use it where you live.