You get Medicare Part A automatically if you've worked and paid taxes

If you or your spouse worked for at least 10 years and paid Medicare taxes (the line on your pay stub that says "Medicare"), you receive Medicare Part A automatically the month you turn 65. You do not need to do anything — Social Security sends the enrollment to Medicare on your behalf. Your Part A coverage starts on the first day of the month you turn 65, even if your birthday is mid-month.

If you have not yet reached 65 but are receiving Social Security disability benefits or have end-stage renal disease, you may already have Part A. Check your Social Security account online or call Social Security at 1-800-772-1213 to confirm what coverage you have.

If you do not meet the 10-year work requirement, you can still purchase Part A by paying a monthly premium. The premium amount depends on how many years you or your spouse worked and paid Medicare taxes. Those who paid for fewer than 30 quarters (roughly 7.5 years) pay the full premium; those with 30 to 39 quarters pay a reduced premium.

Key Takeaways

  • Most people receive Medicare Part A automatically at 65 if they or a spouse worked and paid Medicare taxes for at least 10 years.
  • You must sign up yourself if you are not yet receiving Social Security when you turn 65, even though Part A is automatic for most.
  • If you delay signing up and do not have a valid reason, you may pay a penalty for the rest of your life.
  • Part A covers hospital stays, skilled nursing facility care, hospice, and some home health services, but not doctor visits or outpatient care.
  • You can purchase Part A if you do not have the required work history, though the monthly cost varies based on your work record.

When you must sign up yourself

If you are not receiving Social Security benefits when you turn 65, you must sign up for Medicare Part A yourself. Social Security does not automatically enroll you — you have to take the step. You can sign up online at Medicare.gov, by phone at 1-800-MEDICARE (1-800-633-4227), or in person at your local Social Security office.

The window to sign up without penalty is your Initial Enrollment Period, which runs for seven months: three months before the month you turn 65, the month you turn 65, and three months after. If you sign up during this window, your coverage starts the first day of the month you turn 65 (or the month after, depending on when you sign up). If you miss this window and do not have a valid reason — such as still working and covered by an employer plan — you pay a late enrollment penalty added to your Part A premium for as long as you have Medicare.

The penalty is 10 percent of the standard Part A premium for each full year you were may be able to access but did not sign up. If you waited three years, for example, you would pay 30 percent more than the standard premium, permanently.

What counts as a valid reason to sign up late

You can sign up after your Initial Enrollment Period without penalty if you had creditable coverage — health insurance through your employer or your spouse's employer that was as good as or better than Medicare Part A. This is the most common exception. If you were covered by an active employer health plan when you turned 65, you can sign up for Part A within eight months of losing that coverage and avoid the penalty.

You must be able to show proof that you had this coverage. Keep your insurance cards, benefit statements, or letters from your employer's benefits department. When you sign up, tell Medicare about your employer coverage and provide documentation if they ask.

Other valid reasons include being a federal employee (who had different coverage), living outside the United States, or being a member of certain religious groups that do not believe in insurance. These situations are less common, but if any explore to you, mention them when you sign up.

How to sign up for Medicare Part A

The easiest way is online at Medicare.gov/sign-up. You will need your Social Security number, date of birth, and citizenship or immigration status. The online process takes about 10 minutes. You can also call 1-800-MEDICARE and speak to a representative, or visit your local Social Security office in person. Social Security offices are listed at ssa.gov/locator.

When you sign up, have ready: your Social Security number, your birth certificate or passport, proof of citizenship or legal residency, and information about any health coverage you currently have. If you are signing up late and want to avoid a penalty, bring proof of your employer coverage — an insurance card, a benefits summary, or a letter from your employer stating the dates you were covered.

After you sign up, Medicare sends you a Medicare card in the mail within two to four weeks. Your coverage begins on the date Medicare approves, which is usually the first day of the month you turn 65 (or the month you sign up, if you sign up after turning 65). You can check the status of your process online at Medicare.gov using your login.

What Part A covers and what it does not

Medicare Part A covers inpatient hospital care, including room, meals, and necessary medical services during a hospital stay. It also covers skilled nursing facility care (not regular nursing home care) for up to 100 days after a hospital stay, hospice care for people with terminal illness, and some home health services ordered by a doctor.

Part A does not cover doctor visits, outpatient care, prescription drugs, dental care, vision care, or hearing aids. It also does not cover long-term custodial care in a nursing home — only short-term skilled care after a hospital stay. If you need coverage for doctor visits and outpatient services, you need Medicare Part B. If you want prescription drug coverage, you need Medicare Part D.

Part A has a deductible and coinsurance amounts you pay out of pocket. For 2024, the Part A deductible for a hospital stay is $1,632 per benefit period. After you meet the deductible, Medicare covers all costs for days 1 through 60. From day 61 to day 90, you pay a daily coinsurance amount. These amounts change each year, so check Medicare.gov for the current year's costs.

If you do not have the required work history

If you or your spouse did not work and pay Medicare taxes for at least 10 years, you can still purchase Part A. The monthly premium depends on how many quarters (three-month periods) you or your spouse worked and paid Medicare taxes. A quarter of coverage is earned for each $1,550 in wages you earned in a year (this amount changes yearly).

If you have 30 to 39 quarters of coverage, you pay a reduced premium — roughly 45 percent of the full premium. If you have fewer than 30 quarters, you pay the full premium. For 2024, the full Part A premium is $505 per month for those without the required work history. The reduced premium is about $278 per month. These amounts change each year.

You can find out how many quarters of coverage you have by checking your Social Security account at ssa.gov/myaccount or by calling Social Security at 1-800-772-1213. When you sign up for Part A, Social Security verifies your work record and tells you whether you may have access to for automatic enrollment or must purchase coverage.

Questions to ask your doctor or Social Security

Before you turn 65, ask your current doctor whether they accept Medicare. Not all doctors do, and switching doctors can be disruptive. If your doctor does not accept Medicare, ask for a referral to someone who does in your area.

Ask Social Security or Medicare whether you should also sign up for Part B (doctor and outpatient coverage) at the same time. Most people need both Part A and Part B, and signing up together is simpler than doing it separately later.

If you are still working at 65, ask your employer's benefits department whether your health plan is creditable coverage under Medicare rules. This matters because it affects whether you can delay Part A without penalty and when you must sign up.

When to seek help

Contact Medicare when ready if you turn 65 and do not receive a Medicare card within four weeks of signing up. Call 1-800-MEDICARE to check the status of your process.

If you receive a bill from a hospital or doctor after you turn 65, check whether it is dated after your Medicare coverage started. If it is, the provider should have billed Medicare, not you. Call the provider's billing department and give them your Medicare number. If they continue to bill you, contact Medicare at 1-800-MEDICARE.

If you are unsure whether you have Part A, log into your Social Security account at ssa.gov/myaccount or call Social Security at 1-800-772-1213. They can tell you what coverage you have and when it started.

Frequently Asked Questions

What if I am still working at 65?

You can delay Part B without penalty if you have employer coverage, but Part A is still automatic if you have the required work history. You do not need to sign up for Part A separately — it starts automatically. However, if you do not have the required work history and want Part A, you must sign up yourself during your Initial Enrollment Period.

Can I change my mind after I sign up for Part A?

Yes, but only during specific windows. If you sign up during your Initial Enrollment Period and change your mind within 12 months, you can request to be disenrolled. After that, you can only drop Part A if you have other coverage or during the annual open enrollment period in October through December. Dropping coverage you later want back may result in a penalty.

Do I pay for Part A if I am already receiving Social Security?

Most people do not pay a premium for Part A if they or a spouse worked and paid Medicare taxes for at least 10 years. However, you may pay a small amount if you also enroll in Part B — the Part B premium is deducted from your Social Security check. Part A itself is free for those who meet the work requirement.

What happens if I miss my Initial Enrollment Period?

If you miss the seven-month window and do not have a valid reason like employer coverage, you pay a late enrollment penalty on top of your Part A premium for the rest of your life. The penalty is 10 percent of the standard premium for each full year you were may be able to access but did not sign up. You can still sign up at any time, but the penalty applies permanently.

How do I know if my employer coverage counts as creditable?

Ask your employer's benefits department directly whether your plan meets Medicare's definition of creditable coverage. They should be able to tell you in writing. If you are unsure, keep your insurance cards and benefit statements — you can show these to Medicare when you sign up, and they will determine whether the coverage was creditable.