Free or paid Part A: the 10-year work rule and buying Part A

Part A (hospital insurance) costs most people nothing each month. Whether you pay depends on how long you or your spouse worked and paid Medicare taxes.

Who gets Part A without a premium

You get premium-free Part A if you or your spouse paid Medicare taxes while working for at least 10 years (40 quarters of coverage), in a row or not. You may also get it after 24 months of Social Security or Railroad Retirement Board disability benefits, or sooner with ALS.

What Part A costs if you buy it (2026)

• 30 to 39 quarters of Medicare-taxed work (yours or your spouse's): $311 a month.
• Fewer than 30 quarters: $565 a month.

In most cases, if you buy Part A you must also have Part B and pay both premiums. You can buy Part B without buying Part A. You also must meet Medicare's citizenship or lawful residence rules.

The penalty for waiting

If you have to buy Part A and don't when you're first eligible, your premium may go up 10%, for twice the number of years you could have had it. For example, 2 years late means paying 10% more for 4 years. If you qualify for a Special Enrollment Period, for example because you have coverage from a current job, you may avoid the penalty.

Getting closer to 40 quarters

If you're still working and close to 30 or 40 quarters, more work can lower or end your Part A premium. Social Security can tell you how many quarters you have on your record.

Help paying

If your income and savings are limited, the QMB program pays your Part A premium (along with Part B). Apply through your state Medicaid office; see Medicare Savings Programs and your state's rules.