Most people 65 and older are covered by Medicare Part A automatically

You are covered by Medicare Part A (hospital insurance) when you turn 65 if you or your spouse paid Medicare taxes for at least 10 years while working. You do not need to do anything — coverage starts automatically the month you turn 65. If you were born on the first of the month, coverage begins the month before.

Part A covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. You pay nothing for Part A if you have the work history requirement. If you do not have 10 years of Medicare tax payments, you can still buy Part A coverage, but the monthly premium varies based on how many years you or your spouse worked.

Key Takeaways

  • You are automatically covered by Part A at 65 if you or your spouse paid Medicare taxes for at least 10 years while working in the United States.
  • You must be a U.S. citizen or permanent resident who has lived in the country for at least five consecutive years to be covered.
  • Some people under 65 — those with end-stage renal disease, ALS, or who have received Social Security Disability Insurance for 24 months — can get Part A early.
  • If you do not have 10 years of work history, you can buy Part A coverage starting at age 65, with premiums ranging based on your work record.
  • You should sign up for Part A during your initial enrollment period (the three months before, the month of, and three months after your 65th birthday) to avoid late penalties.

The 10-year work history requirement

The 10 years does not have to be consecutive. Medicare counts 40 work credits, which is roughly 10 years of paying Medicare taxes. You earn one credit for each quarter you work and pay taxes, up to four credits per year. If you worked part-time or had gaps in employment, the credits still add up as long as you paid into the system.

Your spouse's work history counts too. If your spouse has 10 years of Medicare tax payments and you do not, you can still get free Part A at 65 based on their record. You do not need to be currently married — divorced spouses can use an ex-spouse's work history if the marriage lasted at least 10 years and you are at least 62 years old.

Citizenship and residency rules

You must be a U.S. citizen or permanent resident to get Part A. If you are a permanent resident, you must have lived in the United States for at least five consecutive years. Temporary visa holders, undocumented immigrants, and people on work visas do not may have access to for Part A, even if they have paid Medicare taxes.

If you are a permanent resident and have lived in the U.S. for five years or more, you can get Part A at 65 if you also meet the work history requirement. The five-year residency clock resets if you leave the country for more than 30 days, so extended travel abroad can delay your coverage.

Getting Part A before age 65

Three groups of people under 65 can get Part A without waiting:

  • People with end-stage renal disease (permanent kidney failure requiring dialysis or transplant) can get Part A as soon as the month they start dialysis or the month they have a transplant.
  • People with ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) get Part A the same month they are approved for Social Security Disability Insurance.
  • People who have received Social Security Disability Insurance (SSDI) for 24 consecutive months get Part A automatically at the start of their 25th month of disability benefits.

If you fall into one of these groups, you do not need to do anything special — Medicare will enroll you automatically. You will receive a Medicare card in the mail before your coverage begins.

Buying Part A if you do not have 10 years of work history

If you reach 65 without 10 years of Medicare tax payments, you can still buy Part A coverage. The monthly premium depends on how many years you or your spouse worked. In 2024, the premium ranges from about $278 to $505 per month, but these amounts change each year. You must also have Part B (medical insurance) to buy Part A this way.

You can buy Part A during your initial enrollment period (the three months before, the month of, and three months after your 65th birthday). If you miss this window, you can still buy it later, but you may face a higher premium if you wait more than 12 months after you first become may be able to access.

What happens if you delay signing up

If you have free Part A and do not sign up during your initial enrollment period, you will not face a penalty — your coverage will straightforward start the month you turn 65 anyway. However, if you are still working at 65 and have health insurance through your job, you should still sign up for Part A to avoid gaps in coverage when you retire.

If you are buying Part A (because you do not have 10 years of work history), delaying your sign-up beyond your initial enrollment period can add a permanent 10 percent surcharge to your monthly premium for twice the number of years you delayed. For example, if you wait two years to sign up, you pay 20 percent more for life.

How to sign up for Part A

Most people do not need to sign up — Social Security will enroll you automatically in Part A and Part B three months before you turn 65. You will receive your Medicare card about two weeks before your coverage starts.

If you are not yet receiving Social Security benefits, you should sign up for Medicare three months before your 65th birthday. You can do this online at Medicare.gov, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office. If you are buying Part A because you do not have enough work history, you must sign up during your initial enrollment period — Social Security will not enroll you automatically.

Frequently Asked Questions

Can I get Part A if I worked outside the United States?

Work outside the U.S. does not count toward the 10-year requirement, even if you paid taxes in another country. Only work in the United States where you paid Medicare taxes counts. However, some countries have agreements with the U.S. Social Security system that may allow credits to transfer — contact Social Security to ask about your specific situation.

What if I am still working at 65 and have employer health insurance?

You should still sign up for Part A during your initial enrollment period, even if you do not need it yet. Part A has no monthly premium if you have 10 years of work history, so there is no cost to enroll. When you retire and your employer coverage ends, Part A will already be in place.

Does my work history have to be recent?

No. Medicare counts all work credits you earned at any point in your life, as long as you paid Medicare taxes. You do not need to have worked in the last year or even the last decade. If you worked 10 years total and then stopped, you still may have access to for free Part A at 65.

What if I am a widow or widower?

You can use your deceased spouse's work history to get Part A if they had 10 years of Medicare tax payments. You must be at least 60 years old (or 50 if you are disabled). You do not need to have been married for 10 years — any length of marriage counts if your spouse had the work history.

Can I get Part A if I am a permanent resident but have not lived in the U.S. for five years yet?

Not yet. You must have lived in the United States for five consecutive years as a permanent resident before you can get Part A. Once you reach that five-year mark and turn 65, you can enroll if you also meet the work history requirement.