Most people 65 and older get free Medicare Part A automatically

You receive free Medicare Part A (hospital insurance) at 65 if you or your spouse paid Medicare taxes for at least 10 years while working. You do not have to do anything — Medicare enrolls you automatically if you are receiving Social Security benefits. If you are not yet taking Social Security, you will need to contact Social Security or Medicare to confirm your enrollment.

Part A covers hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. There is no monthly premium for Part A if you meet the work history requirement, though you will pay a deductible when you use hospital services.

Some people who do not have a 10-year work history can still receive free Part A. Your spouse's work record, your ex-spouse's record (if you were married at least 10 years), or your parent's record (if you are 62 or older) can count toward the requirement. Government employees hired before 1983 who did not pay Medicare taxes may have different rules.

Key Takeaways

  • You get free Part A at 65 if you or your spouse paid Medicare taxes for at least 10 years during your working years.
  • Medicare enrolls you automatically if you are receiving Social Security; otherwise you must contact Social Security or Medicare to confirm enrollment.
  • Your ex-spouse's or parent's work record can count toward the 10-year requirement if you meet other conditions.
  • Free Part A means no monthly premium, but you will pay a deductible when you use hospital services.
  • If you do not meet the work history requirement, you can purchase Part A coverage for a monthly premium.

How Medicare counts your work history

Medicare measures your work history in credits. You earn one credit for each $1,640 in wages you paid Medicare taxes on in 2023 (this amount changes each year). You can earn a maximum of four credits per year. To receive free Part A, you need 40 credits total, which usually means 10 years of work.

The work does not have to be recent. If you worked 10 years at any point in your life and paid Medicare taxes, you meet the requirement. Self-employed people also earn credits when they pay self-employment tax. The Social Security Administration keeps a record of your credits, and you can view your record online or request a paper copy.

If you are close to 40 credits but not quite there, you may still be able to get free Part A through a family member's record. This is worth checking before you assume you will have to pay a premium.

Using your spouse's or ex-spouse's work record

If your spouse has 40 credits, you can receive free Part A at 65 even if you have no work history yourself. You do not need to be the same age as your spouse, and your spouse does not need to have started taking Social Security yet — they just need to be at least 62 years old.

An ex-spouse's record works the same way if your marriage lasted at least 10 years and you are at least 62 years old. You do not need your ex-spouse's permission, and they do not need to know you are using their record. If you have been divorced for at least two years, you can use their record even if they have not yet taken Social Security.

If you have been married more than once and each marriage lasted 10 years or longer, you can choose which ex-spouse's record to use. Social Security can help you figure out which choice gives you the best outcome.

Using your parent's work record if you are 62 or older

If one of your parents has 40 credits and you are at least 62 years old, you may receive free Part A based on their record. Your parent does not need to be alive — you can use a deceased parent's record. Your parent does not need to have taken Social Security.

This rule is less common than spousal or ex-spousal coverage because it requires you to be 62 or older and your parent to have worked long enough. If you lost a parent early in your life or your parent did not work long enough to earn 40 credits, this route will not be open to you.

What happens if you do not have 40 credits

If you reach 65 without 40 credits and cannot use a family member's record, you can still purchase Part A coverage. The monthly premium depends on how many credits you have earned. In 2024, the premium ranges from about $278 to $506 per month, depending on your work history. These amounts change each year.

You can purchase Part A at any time after 65, but waiting longer does not lower the cost. If you delay enrolling in Part A when you first become may be able to access, you may face a late enrollment penalty that raises your premium permanently. The penalty is 10 percent of the standard premium for each full year you delayed.

Some people who do not meet the work history requirement choose to purchase Part A because they expect to use hospital services. Others skip it and rely on Part B and Part D coverage only. This is a choice to discuss with your doctor or a Medicare counselor, since the decision depends on your health and financial situation.

Government employees and special work situations

Federal employees hired before 1983 may not have paid Medicare taxes, even though they worked full-time. These employees have different rules for Part A coverage. Some may receive free Part A based on their government service; others may need to purchase it. If you were a federal employee, contact Medicare directly to learn what applies to you.

Railroad workers, certain religious workers, and people who worked in other countries may also have special rules. The safest approach is to contact Social Security or Medicare with details about your work history and ask them to review your specific situation.

How to confirm your Part A enrollment

If you are receiving Social Security, Medicare automatically enrolls you in Part A when you turn 65. You will receive a Medicare card in the mail about two weeks before your 65th birthday. Check the card to make sure it shows Part A coverage.

If you are not receiving Social Security, contact Social Security at 1-800-772-1213 or visit your local Social Security office to request Medicare enrollment. You can also contact Medicare directly at 1-800-MEDICARE (1-800-633-4227). Have your Social Security number ready when you call.

If you are already 65 and do not have a Medicare card, contact Medicare right away. Enrollment can happen at any age, but delays may result in a late enrollment penalty.

Frequently Asked Questions

Do I have to be a U.S. citizen to get free Part A?

You must be a U.S. citizen or a permanent resident who has lived in the United States for at least five consecutive years. If you are not a citizen or permanent resident, you cannot receive free Part A based on your own work record, though you may be able to use a family member's record if they meet the citizenship requirement.

What if I worked in another country?

Work you did in another country may count toward your 40 credits if that country has a Social Security agreement with the United States. Contact Social Security to find out whether your foreign work history counts. You will need to provide documentation of your work and earnings from that country.

Can I get free Part A if I am still working at 65?

Yes. Your work status does not affect your right to free Part A. You become may be able to access at 65 based on your lifetime work history, whether you are still working or retired. If you are still working and have employer health insurance, you may choose to delay enrolling in Part B, but Part A enrollment happens automatically if you are receiving Social Security.

What if I delayed taking Social Security past 65?

If you did not take Social Security at 65, you still need to contact Social Security or Medicare to enroll in Part A. Medicare does not enroll you automatically unless you are receiving Social Security benefits. Call Social Security at 1-800-772-1213 to request enrollment, even if you plan to delay your Social Security benefits.

Does my Part A premium ever change if I get it for free?

No. If you receive free Part A based on 40 credits, you pay no monthly premium for the rest of your life. You will still pay a deductible when you use hospital services, and that deductible amount changes each year, but your premium stays at zero.