Not everyone pays the same amount for Medicare, and some people pay nothing at all

Medicare is partly funded by taxes — money taken from your paycheck while you work — and partly by what you pay when you use it. Whether you pay anything depends on your work history, your income now, and which part of Medicare you use. Most people who worked 10 years or more in jobs covered by Social Security pay nothing for Part A (hospital insurance). Part B (doctor visits) costs most people a monthly premium, though the amount varies. Part D (prescription drugs) has a premium that changes by plan. If your income is low enough, you may pay reduced amounts or nothing.

The key distinction is between what you earned through work and what you earn now. Your past work record determines whether Part A is free. Your current income determines whether you get help paying Part B and Part D premiums. These are separate calculations, so you might have free Part A but still pay for Part B, or you might have to buy Part A but get help with Part B because your income is low.

Key Takeaways

  • Part A (hospital insurance) is free for most people who worked at least 10 years in jobs that paid Medicare taxes, even if they never paid income tax.
  • Part B (doctor visits) costs a monthly premium for nearly everyone, though the amount depends on your income and when you first became may be able to access.
  • If your income is below a certain level, you may pay reduced premiums for Part B and Part D, or nothing at all.
  • Spouses and ex-spouses can get free Part A based on someone else's work record, even if they never worked themselves.
  • People who did not work long enough to may have access to for free Part A can buy it, though the cost is high.

How Part A (Hospital Insurance) Works

Part A covers hospital stays, skilled nursing care, hospice, and some home health services. You get it free at 65 if you or your spouse worked at least 10 years in a job where Medicare taxes were taken from your paycheck. You do not have to have paid income tax — only Medicare tax matters. If you worked fewer than 10 years, you can still buy Part A, but the monthly cost is high (the exact amount changes each year).

Divorced people can use an ex-spouse's work record if the marriage lasted at least 10 years and you are at least 62. You do not need permission from your ex, and it does not reduce what they receive. Spouses who never worked can get free Part A the same way — based on the working spouse's record. This applies whether the spouse is still living or deceased, as long as the marriage lasted at least 10 years.

If you are not yet 65 and have been on Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS, you can get Part A before 65. Otherwise, you must wait until 65 to enroll, and waiting past 65 without a good reason can mean a permanent penalty on your premiums if you later buy Part A.

How Part B (Doctor and Outpatient Care) Works

Part B covers doctor visits, outpatient surgery, lab tests, imaging, and some preventive care. Nearly everyone on Medicare pays a monthly premium for Part B. The standard premium amount changes each year — your actual premium may be higher if your income from two years ago was above a certain threshold. The income thresholds and surcharge amounts are set by Medicare and published each year.

You enroll in Part B when you turn 65, usually at the same time as Part A. If you delay enrollment and do not have employer coverage, you pay a permanent 10 percent penalty for each year you waited. The penalty stays with you for life, so enrolling on time matters even if you do not plan to use it when ready. The only exception is if you have employer health insurance through your own job or your spouse's job — then you can delay without penalty.

If your income is low, you may be able to get help paying Part B premiums through a program called Medicaid (run by your state) or through a federal program called the Medicare Savings Program. Each state runs its own version, and income limits vary. You contact your state Medicaid office to find out whether you may have access to.

How Part D (Prescription Drug Coverage) Works

Part D is optional, but you should enroll when you turn 65 or within 63 days of losing other drug coverage. If you wait longer without a reason, you pay a permanent penalty. The monthly premium varies by plan — some cost very little, others cost significantly more — and the premium changes every year. You choose which plan to enroll in based on the drugs you take and the pharmacies you use.

If your income is below 150 percent of the federal poverty line, you pay nothing for Part D premiums and have reduced copays for drugs. If your income is between 150 and 200 percent of poverty, you get partial help. Your state's Medicaid program determines whether you may have access to and how much help you receive. The income thresholds change yearly.

Even if you do not take prescription drugs now, enrolling in a plan (even a low-cost one) protects you from the lifetime penalty if you need drugs later. The penalty is calculated based on how long you went without coverage, so the sooner you enroll, the lower your future penalty will be.

Income-Based Help With Premiums

If your income is low, you may pay nothing for Part B and Part D premiums. The main programs are the Medicare Savings Program (MSP) and the Low-Income Subsidy (LIS) for Part D. Both are run by your state's Medicaid office, not by Medicare itself. You contact your state Medicaid office directly to ask about these programs.

To find out whether you may have access to, you will need to report your income and assets. Income limits change yearly and vary by state. Having savings or a home does not usually disqualify you — only income matters for most programs. If you may have access to, the program pays your Part B premium directly to Medicare, and you pay nothing. For Part D, the program pays the premium and reduces your copays for drugs.

You can reach your state Medicaid office through your state health department website, or you can call 1-800-MEDICARE and ask for a referral. The process usually takes a few weeks. Once you are approved, the help is automatic — you do not have to reapply each month.

What Happens If You Never Worked or Worked Very Little

If you did not work 10 years in a Medicare-covered job, you do not get free Part A. You can buy it, but the cost is steep — the full premium is higher than the reduced premium, and the exact amount changes each year. If you worked 30 to 39 quarters (roughly 7.5 to 10 years), you pay a reduced premium. You still have to pay for Part B and Part D the same way everyone else does.

If your income is very low, you may still get help through Medicaid or the Medicare Savings Program, even if you have to buy Part A. Some states cover the Part A premium for people below a certain income threshold. Call your state Medicaid office to ask what programs are available in your state and whether you might may have access to.

Immigrants who became citizens after age 65 may not have a long enough U.S. work record to may have access to for free Part A. The same rules explore — you can buy it, or you may get help through Medicaid if your income is low enough. Work done before becoming a U.S. citizen generally does not count toward the 40 quarters, but you can ask Social Security to review your specific record.

How Work History Affects What You Pay

Your work history is measured in quarters of coverage. You earn one quarter for each three-month period in which you earned at least a minimum amount set by Social Security each year. You need 40 quarters (10 years) to get free Part A. The quarters do not have to be recent — work from decades ago counts just as much as recent work.

If you worked in a job not covered by Medicare — such as some government jobs, railroad work, or certain foreign employment — those quarters do not count toward the 40. However, if you later worked in a covered job, those quarters do count. You can check your work record by creating an account on ssa.gov or by calling Social Security at 1-800-772-1213. Social Security will send you a statement showing how many quarters you have earned.

If you are close to 40 quarters but not quite there, working a bit longer may get you to free Part A. Even one more quarter can reduce the premium you have to pay if you buy Part A. If you are already 65 and still working, you can continue to earn quarters and may eventually reach 40, which would make Part A free retroactively in some cases.

Frequently Asked Questions

Do I have to pay for Medicare if I am still working?

You still pay Medicare taxes on your wages (1.45 percent of your paycheck), but you do not have to enroll in Medicare itself until 65 or until you stop working. If you have employer health insurance, you can delay enrolling in Part B without penalty. However, you should still enroll in Part A at 65 even if you are working, because it is free and has no downside.

What if I worked outside the United States?

Work outside the U.S. generally does not count toward the 40 quarters needed for free Part A, unless you worked for the U.S. government or a U.S. employer. Some countries have agreements with the U.S. that allow work to count. Call Social Security at 1-800-772-1213 to ask about your specific situation and have them review your record.

Can my spouse get free Part A if I worked but they did not?

Yes. If you have 40 quarters of coverage, your spouse can get free Part A at 62 (if you are at least 62) or at any age if you are at least 62 and they are caring for your child under 16. A divorced spouse can also use your record if the marriage lasted 10 years and they are at least 62.

Do I pay more for Medicare if I have other insurance?

No. Your Medicare premiums do not change based on whether you have other insurance. However, if you have employer coverage, you may want to delay Part B enrollment to avoid paying for both. Make sure you enroll within 63 days of losing the employer coverage, or you will face a permanent penalty.

What if I cannot afford any of the premiums?

Contact your state Medicaid office or call 1-800-MEDICARE to ask about the Medicare Savings Program and the Low-Income Subsidy. These programs cover premiums and reduce copays for people with low income. You may also may have access to for Medicaid itself, which covers costs Medicare does not.