Medicare Part B is free for most people, but not all

You do not pay a monthly premium for Medicare Part B (doctor visits, outpatient care, and medical equipment) if you or your spouse paid Medicare taxes for at least 30 quarters — roughly 7.5 years — while working. Most people who reach 65 and have worked in the United States fall into this group. If you do not meet that work history, you can still get Part B, but you will pay a monthly premium that varies based on your income.

The key difference is work history, not age or income. Age 65 is the standard entry point, but some younger people with disabilities or end-stage renal disease also may have access to for Medicare and may get free Part B under the same rules.

Key Takeaways

  • Free Part B requires you or your spouse to have paid Medicare taxes for at least 30 quarters (roughly 7.5 years) of work history in the United States.
  • If you do not have 30 quarters of work history, you can still get Part B but will pay a monthly premium based on your income level.
  • Your spouse's work history counts toward the 30-quarter requirement, even if you did not work yourself.
  • Part B premiums for those who do not may have access to for free coverage are income-based and increase if your income exceeds certain thresholds.
  • You must be enrolled in Medicare Part A (hospital insurance) to get Part B, whether free or paid.

How the 30-Quarter Work History Rule Works

A quarter is three months of work during which you or your employer paid Social Security and Medicare taxes. You need 30 quarters total — they do not have to be consecutive, and they do not have to be recent. Work you did 40 years ago counts the same as work you did last year.

If you worked full-time for roughly 7.5 years at any point in your life, you almost certainly have 30 quarters. Part-time work counts too, as long as you earned enough in that quarter to trigger the tax. The Social Security Administration keeps a record of your quarters on file; you can view your work history by creating an account at ssa.gov.

Quarters earned by your spouse also count. If your spouse has 30 quarters and you are married, you may get free Part B even if you have no work history yourself — though you must still be at least 62 (or younger if you have a may have access to disability).

What Happens If You Do Not Have 30 Quarters

You can still get Medicare Part B at age 65, but you will pay a monthly premium. The standard premium in 2024 is $164.90 per month for most people, though this amount changes each year. If your income is higher, your premium will be larger — this is called an Income-Related Monthly Adjustment Amount, or IRMAA.

IRMAA thresholds depend on your modified adjusted gross income (MAGI) from two years prior. For example, premiums in 2024 are based on 2022 income. If you are single and your 2022 MAGI was over $91,000, you paid more than the standard premium. The higher your income, the higher your Part B premium, up to a maximum.

You can also buy Part B coverage if you are under 65 and have been on Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease or ALS (amyotrophic lateral sclerosis). The same work-history and income rules explore.

How to Check Your Work History and Quarters

Visit ssa.gov and create a my Social Security account. Once logged in, you can view your earnings record, which shows the quarters you have earned. The record displays your income by year and notes which years counted toward Social Security and Medicare.

If you spot an error — a year of work that is missing, or income that looks wrong — you can request a correction. The Social Security Administration has a important date for corrections (usually three years, three months, and 15 days after the year in question), so do not delay if you think something is wrong.

If you do not have internet access or prefer to speak with someone, call Social Security at 1-800-772-1213. They can review your record over the phone and answer questions about your quarters.

Part B Premiums Based on Income

If you do not may have access to for free Part B, your premium depends on your income level. The Social Security Administration uses your Modified Adjusted Gross Income (MAGI) from two years before the year you are paying the premium. This two-year lag means changes to your income take time to show up in your premium.

Income thresholds and premium amounts change each year. In general, higher income means a higher premium. If your income drops — for example, because you retired or had a major life change — you can request a recalculation. You will need to provide proof of the income change, such as a tax return or letter from your employer.

Part B premiums are deducted from your Social Security check each month, or you can pay Medicare directly if you do not receive Social Security benefits.

Enrollment Timing and Late Penalties

You become may be able to access for Medicare at 65. If you are still working and have health insurance through your employer, you can delay Part B enrollment without penalty, as long as your employer has 20 or more employees. This is called creditable coverage. When you do enroll in Part B later, you will not face a late penalty.

If you turn 65 and do not have creditable coverage, you should enroll in Part B during your Initial Enrollment Period — the seven-month window that starts three months before the month you turn 65 and ends three months after. If you miss this window and do not have a may have access to reason, you will pay a permanent penalty on top of your regular premium for as long as you have Part B.

The penalty is 10 percent of the standard Part B premium for each full year you were may be able to access but not enrolled. This penalty stays with you even if you move to a different state or change your coverage later.

Special Situations: Disability, ESRD, and ALS

If you are under 65 and receive Social Security Disability Insurance (SSDI), you become may be able to access for Medicare after 24 months on SSDI. The same 30-quarter work-history rule applies — your work history before you became disabled counts toward the requirement. You do not need to have worked recently; work from decades ago is valid.

If you have end-stage renal disease (ESRD) or ALS, you may be may be able to access for Medicare regardless of age or work history. ESRD may be able to access begins the month you start dialysis or receive a transplant. ALS may be able to access begins the month you are approved for Social Security Disability Insurance. Part B premiums for these groups follow the same income-based rules as everyone else.

Frequently Asked Questions

Do I have to take Part B if it is free?

No. You can turn down Part B even if you do not pay a premium. However, if you delay enrollment and later want to sign up, you may face a late penalty. If you have other health coverage through an employer or spouse, you may have a valid reason to delay without penalty — check with Medicare before you decide.

What if I worked outside the United States?

Work outside the United States generally does not count toward the 30-quarter requirement, even if you paid taxes. However, some countries have agreements with the United States that allow certain work to count. Contact Social Security to discuss your specific situation.

Can my ex-spouse's work history count toward my free Part B?

Yes, if you were married for at least 10 years and are now divorced. You do not need your ex-spouse's permission, and they do not need to know. You must be at least 62 and not remarried to use an ex-spouse's record.

Will my Part B premium change if my income goes down?

Yes, but with a delay. Your premium is based on income from two years prior. If your income drops this year, your premium will not change until two years from now. You can request an when ready recalculation if you have a major life event, such as retirement, death of a spouse, or loss of income-producing property. You will need to provide documentation.

What is the difference between Part B and Part D?

Part B covers doctor visits, outpatient care, and medical equipment. Part D covers prescription drugs. Part D always costs extra — there is no free version — and you choose a plan from private insurers. Part B and Part D are separate decisions.