Medicare Part A is free for most people. If you or your spouse paid Medicare taxes while working for at least 10 years (40 quarters), you qualify for what’s called “premium-free Part A,” meaning you pay $0 in monthly premiums. About 99% of Medicare beneficiaries fall into this category. But free premiums don’t mean zero costs. Part A still comes with deductibles and coinsurance when you actually use it.
How You Qualify for Premium-Free Part A
The 10-year rule is the main threshold. Throughout your working life, each year you earn above a minimum amount counts as four “quarters of coverage,” or credits. You need 40 credits total, which works out to roughly 10 years of work where you paid Medicare payroll taxes. These don’t need to be consecutive years.
You don’t have to rely solely on your own work history. You can also qualify based on the earnings of a spouse, former spouse, deceased spouse, or even a parent. If your spouse worked 10 years and paid Medicare taxes, you’re eligible for premium-free Part A too. For former spouses, the marriage generally needs to have lasted at least 10 years.
Who Gets Part A Before Age 65
Most people enroll in Medicare at 65, but two groups qualify earlier. If you receive Social Security disability benefits, you’re automatically enrolled in Part A after 24 months of receiving those benefits. Government employees with disabilities who aren’t eligible for Social Security follow a slightly longer timeline of 29 months.
People with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant) can get Medicare at any age, as long as they or a spouse or parent has the required work history under Social Security or government employment. This is one of the few ways someone under 65 without a disability can access Medicare.
What Part A Costs if You Don’t Qualify
If you or your spouse didn’t work long enough to earn 40 credits, you can still buy Part A, but it’s expensive. In 2025, you’ll pay one of two monthly premiums depending on how many credits you have. People with 30 to 39 credits pay $311 per month. Those with fewer than 30 credits pay $565 per month. That adds up to $3,732 or $6,780 per year just for the premium.
There’s also a penalty for signing up late. If you were eligible to buy Part A but didn’t enroll during your initial enrollment period, your premium increases by 10%. You’ll pay that higher rate for twice the number of years you went without coverage. So if you delayed enrollment by two years, you’d pay the penalty for four years.
Out-of-Pocket Costs Even With Free Premiums
Premium-free doesn’t mean cost-free when you need care. Part A covers hospital stays, skilled nursing facilities, hospice, and some home health care, but each comes with its own cost sharing.
The biggest expense is the inpatient hospital deductible: $1,676 per benefit period in 2025. A benefit period starts when you’re admitted to a hospital and ends once you’ve been out for 60 consecutive days. If you’re hospitalized twice within 60 days, you pay the deductible once. If you’re hospitalized again after a 60-day gap, you pay it again. There’s no annual limit on how many times you might owe this deductible.
For longer hospital stays, additional coinsurance kicks in. Days 1 through 60 are fully covered after the deductible. From day 61 through 90, you pay $419 per day. Beyond 90 days, you dip into a lifetime reserve of 60 extra days at $838 per day. Once those reserve days are used up over the course of your lifetime, they don’t renew.
Skilled nursing facility care follows a different structure. The first 20 days are covered in full (after a qualifying hospital stay of at least 3 days). Days 21 through 100 carry a coinsurance of $217 per day. After day 100, Medicare stops covering skilled nursing entirely.
How to Check Your Credit Count
If you’re unsure whether you’ve earned enough credits, the easiest way to check is by creating an account at ssa.gov. Your Social Security statement lists your total credits and your year-by-year earnings history. This shows exactly how many quarters of coverage you’ve accumulated and whether you’re on track for premium-free Part A.
If you’re close to 40 credits but not quite there, even part-time work that generates Medicare tax withholdings can help you reach the threshold. The income needed per credit is relatively low (a few thousand dollars per quarter), so even a year or two of additional work could make the difference between paying nothing and paying over $500 a month.