Most people 65 and older automatically get Medicare Part A

You get Medicare Part A automatically when you turn 65 if you or your spouse paid Medicare taxes for at least 10 years while working. You do not have to do anything — Social Security enrolls you unless you ask them not to. Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health services.

If you were born on the first of the month, Medicare coverage starts the month before you turn 65. If you were born on any other day, coverage starts the month you turn 65. You will receive a Medicare card in the mail about three months before your coverage begins.

Some people under 65 also get Part A: those who have received Social Security disability benefits for 24 months, those with end-stage renal disease, and those with ALS (amyotrophic lateral sclerosis). If you fall into one of these groups, you become covered automatically when you meet the time requirement.

Key Takeaways

  • You get Medicare Part A automatically at 65 if you or your spouse paid Medicare taxes for at least 10 years while working in the United States.
  • You do not need to sign up — Social Security enrolls you automatically unless you tell them to delay.
  • If you did not pay Medicare taxes for 10 years, you can still buy Part A, though the monthly cost is higher.
  • Some people under 65 get Part A if they have received disability benefits for 24 months, have end-stage renal disease, or have ALS.
  • Your Medicare card arrives about three months before your coverage starts, and you should check it for errors before using it.

If you did not work long enough to get Part A free

You can still buy Medicare Part A if you do not meet the 10-year work requirement, but you will pay a monthly premium. The cost depends on how many years you or your spouse paid Medicare taxes. If you paid for fewer than 30 quarters (about 7.5 years), the premium is higher than if you paid for 30 to 39 quarters. The exact amount changes each year.

To buy Part A, you must contact Social Security directly. You cannot buy it through Medicare.gov or by calling Medicare — Social Security handles enrollment for people who do not meet the automatic coverage rule. Call Social Security at 1-800-772-1213, visit your local Social Security office, or go to ssa.gov to set up an appointment.

If you are not yet 65 and do not fall into the disability or kidney disease categories, you cannot buy Part A until you turn 65. You will need to wait until then to enroll.

What happens if you delay enrolling in Part A

If you are still working at 65 and have health coverage through your job, you can delay Part A enrollment without penalty. You have eight months after your employment ends or your coverage stops — whichever comes first — to sign up without paying extra. This is called the Special Enrollment Period.

If you miss this window and do not sign up when you become may be able to access, you will pay a penalty for as long as you have Part A. The penalty is 10 percent of the standard monthly premium for each full year you were may be able to access but not enrolled. This penalty is permanent and does not go away.

The exception is if you have group health coverage through current employment. In that case, you can delay without penalty as long as you are still working and covered by that plan. Once you leave the job or lose the coverage, you have a limited time to enroll without penalty.

Checking your work history and coverage status

Before you turn 65, you can check your earnings record on ssa.gov to see how many years of Medicare taxes you paid. Create a my Social Security account, sign in, and look at your earnings record. This shows your work history year by year and tells you whether you have enough credits for free Part A.

You can also call Social Security at 1-800-772-1213 to ask about your work history and whether you will get Part A automatically. Have your Social Security number ready. They can tell you the exact month your coverage will start and answer questions about your specific situation.

About three months before your 65th birthday, check your mail for your Medicare card. When it arrives, look it over carefully. Make sure your name, date of birth, and Social Security number are correct. If anything is wrong, call Medicare at 1-800-MEDICARE (1-800-633-4227) to report the error.

Non-citizens and Medicare Part A

You must be a U.S. citizen or a lawful permanent resident (green card holder) to get Medicare Part A. If you are a lawful permanent resident, you must have lived in the United States for at least five years before you turn 65.

If you are not a citizen or permanent resident, you cannot get Medicare Part A, even if you paid Medicare taxes while working. Some people in this situation may have other coverage options through their state or through the Affordable Care Act marketplace, but those are separate from Medicare.

What Part A covers and what it does not

Medicare Part A covers the hospital portion of your care: inpatient hospital stays, skilled nursing facility care (after a hospital stay of at least three days), hospice care, and some home health services. It does not cover doctor visits, outpatient care, prescription drugs, dental, vision, or hearing aids.

Part A has a deductible you pay each time you are admitted to the hospital, and it has copayments for skilled nursing care after day 20. If you stay in the hospital for a long time, you may owe more. Many people buy Medicare Part B and Medigap or Medicare Advantage to cover the gaps Part A leaves.

Questions to ask your doctor or Social Security

Before you turn 65, ask your current doctor whether they accept Medicare. Ask whether they will be your doctor under Medicare or whether you need to find a new one. If you have ongoing treatment or prescriptions, ask how Medicare will affect your care.

If you are still working at 65, ask your employer's benefits office whether your group health plan is primary (pays first) or secondary to Medicare. This affects when you need to enroll in Part A and whether you will face a penalty for delaying.

Call Social Security before your 65th birthday to confirm you will get Part A automatically and to ask when your coverage starts. If you think you might not have enough work history, ask them to review your earnings record with you.

Frequently Asked Questions

Do I have to sign up for Medicare Part A, or does it happen automatically?

It happens automatically. Social Security enrolls you in Part A when you turn 65 if you meet the work requirement. You will receive a Medicare card in the mail about three months before coverage starts. You do not need to do anything unless you want to delay enrollment because you are still working and have employer coverage.

What if I worked outside the United States?

Work outside the U.S. generally does not count toward the 10-year requirement for free Part A. However, some countries have agreements with the United States that allow certain work to count. Call Social Security at 1-800-772-1213 to ask whether your work history qualifies.

Can I get Part A if I am not a U.S. citizen?

You must be a U.S. citizen or a lawful permanent resident to get Medicare Part A. If you are a permanent resident, you must have lived in the United States for at least five years. If you do not meet these requirements, you cannot get Medicare, but you may have other coverage options through your state or the Affordable Care Act marketplace.

What is the penalty for signing up late for Part A?

If you do not sign up when you become may be able to access and do not have a valid reason to delay, you pay a 10 percent penalty on your monthly premium for each full year you were may be able to access but not enrolled. This penalty is permanent. The only way to avoid it is to enroll during your initial enrollment period or within eight months of losing employer coverage.

Does Part A cover doctor visits and prescriptions?

No. Part A covers hospital stays, skilled nursing care, hospice, and some home health services. It does not cover doctor visits, outpatient care, prescription drugs, dental, vision, or hearing. Most people buy Part B to cover doctor visits, and many add Medigap or Medicare Advantage for additional coverage.