Most people pay nothing for Medicare Part A if they or their spouse paid Medicare taxes for at least 10 years

If you worked and paid Medicare taxes (the 1.45% deduction from your paycheck) for at least 10 years, you won't pay a monthly premium for Medicare Part A when you turn 65. This covers hospital stays, skilled nursing care, hospice, and some home health services. The cost you do pay comes in the form of a deductible when you use the hospital, not as an ongoing premium.

If you didn't work long enough to may have access to for premium-free Part A, you can still get it by paying a monthly premium. The amount depends on how many quarters of Medicare tax you paid. Someone who paid for 30 to 39 quarters pays less than someone who paid for fewer than 30 quarters. These amounts change each year.

Key Takeaways

  • Most people over 65 pay no monthly premium for Part A if they or a spouse paid Medicare taxes for at least 10 years.
  • If you don't may have access to for premium-free Part A, you can buy it, but the monthly cost varies based on your work history and changes yearly.
  • Even with premium-free Part A, you pay a deductible each time you enter the hospital, and the amount depends on the length of your stay.
  • If you delay signing up for Part A when you first become may be able to access, you may face a permanent penalty on your premium.

The deductible you pay when you use the hospital

The real cost of Part A shows up when you actually use it. When you're admitted to the hospital, you pay a deductible — a flat amount that resets every 60 days. After you pay the deductible, Medicare covers your hospital bills for the first 60 days of that hospital stay. This deductible amount changes each year.

If your hospital stay goes beyond 60 days, you start paying a daily coinsurance amount for days 61 through 90. If you need to stay even longer, the costs increase further. For skilled nursing facilities (like a nursing home after a hospital stay), you pay nothing for the first 20 days, then a daily coinsurance amount for days 21 through 100.

When you don't may have access to for premium-free Part A

If you didn't work long enough to may have access to for premium-free Part A, Social Security will tell you the exact monthly premium when you first contact them about Medicare. The amount depends on whether you paid Medicare taxes for 30 to 39 quarters (fewer years of work) or fewer than 30 quarters (very limited work history). Someone with 30 to 39 quarters pays less than someone with fewer quarters.

You can also buy Part A if you're under 65 and have been receiving Social Security disability benefits for at least 24 months, or if you have end-stage renal disease or ALS. In those cases, you'll also pay a monthly premium based on your specific situation.

What happens if you sign up late

If you don't sign up for Part A when you first become may be able to access at 65, and you don't have a valid reason for the delay, you may face a permanent penalty. The penalty is a percentage increase to your monthly premium that stays with you for life. The longer you wait, the higher the penalty. This is one of the few Medicare penalties that never goes away, so signing up on time matters even if you don't plan to use it right away.

The exception is if you're still working and covered by your employer's health plan. In that case, you can delay Part A without penalty as long as you sign up within 8 months of leaving that job or losing the coverage.

How Part A costs compare to other Medicare parts

Part A covers hospital and facility care, while Part B (doctor visits and outpatient care) has its own monthly premium that most people do pay. Part A's costs are mainly the deductible and coinsurance when you use it, whereas Part B costs you every month whether you use it or not. Part D (prescription drugs) also has a monthly premium. Many people buy Medigap or Medicare Advantage plans to reduce their out-of-pocket costs across all parts.

If you're trying to decide whether to buy Part A when you don't may have access to for it premium-free, think about your health and family history. Someone in good health might decide the monthly premium isn't worth it, while someone with a history of hospitalizations might find it protects them from much larger bills.

How to find out your specific Part A cost

The only way to know your exact premium (if you don't may have access to for premium-free Part A) is to contact Social Security directly. You can call 1-800-772-1213, visit your local Social Security office, or go to ssa.gov. Have your Social Security number ready, and they'll look up your work history to tell you which premium tier you fall into.

If you're already on Medicare, you can see your Part A deductible and coinsurance amounts on your Medicare.gov account or on your Medicare card. These amounts are published each year, usually in the fall, so you can plan ahead if you know you'll need hospital care.

Frequently Asked Questions

Do I have to pay for Part A if I'm still working?

No. If you're covered by your employer's health plan and still working, you don't have to sign up for Part A at 65. You can delay without penalty as long as you sign up within 8 months of leaving that job or losing the coverage. After that window closes, a late-enrollment penalty applies.

What's the difference between the Part A deductible and coinsurance?

The deductible is a flat amount you pay once per hospital stay (or per 60-day period). After you pay it, Medicare covers most costs for the first 60 days. Coinsurance is a daily amount you pay if your stay goes beyond 60 days. Both amounts reset and change each year.

Can I get Part A without Part B?

Yes. You can sign up for Part A alone if you want to. However, if you delay Part B when you first become may be able to access, you may face a permanent penalty on Part B's premium later. Part A and Part B have separate enrollment rules and separate penalties.

Does Part A cover doctor visits?

No. Part A covers hospital stays, skilled nursing facilities, hospice, and some home health services. Doctor visits and outpatient care are covered by Part B, which is a separate part of Medicare with its own premium and deductible.

What if I worked outside the United States?

Work done outside the U.S. generally doesn't count toward the 10 years needed for premium-free Part A, with some exceptions for people who worked for the U.S. government or in certain countries with Social Security agreements. Contact Social Security to discuss your specific work history.