Medicare Part A is free at age 65 for most people, but not everyone. The key requirement is having at least 40 work credits (roughly 10 years of employment) where you or your spouse paid Medicare taxes. If you meet that threshold, you pay $0 in monthly premiums for Part A, which covers hospital stays, skilled nursing care, and hospice. If you fall short, you could pay up to $565 per month.
How Work Credits Determine Your Premium
The Social Security Administration tracks your work history using “quarters of coverage,” commonly called work credits. You can earn up to four credits per year. In 2025, you earn one credit for every $1,810 in wages or self-employment income, meaning you’d need to earn $7,240 in a year to max out all four credits. Once you’ve accumulated 40 credits over your working life, you qualify for premium-free Part A at 65.
These credits don’t need to be consecutive. If you worked for seven years in your twenties, took time off, and then worked another three years later, those 10 total years still count. The credits stay on your record permanently.
Qualifying Through a Spouse’s Work Record
You don’t necessarily need 40 credits of your own. You can qualify for free Part A based on your spouse’s work history if your spouse has earned at least 40 credits. This applies whether your spouse is currently alive or deceased, and it also applies to former spouses as long as the marriage lasted at least 10 years. This rule is especially important for people who spent years as stay-at-home parents or caregivers and didn’t accumulate enough credits independently.
What Happens If You Don’t Have Enough Credits
If you have fewer than 40 credits, Part A is not free. People with 30 to 39 credits pay a reduced monthly premium. Those with fewer than 30 credits pay the full amount, which in 2026 runs up to $565 per month. That’s a significant cost, roughly $6,780 a year, just for the Part A premium alone.
There’s also a late enrollment penalty if you don’t sign up when you’re first eligible and later decide to buy in. Your monthly premium increases by 10%, and you pay that penalty for twice the number of years you went without coverage. If you waited three years past your eligibility, for example, you’d pay the higher premium for six years.
Government Employees and Teachers
Some public sector workers, particularly certain state and local government employees and teachers, didn’t pay into Social Security during parts of their careers. However, many of these positions did pay Medicare taxes separately. If you worked in government employment and paid Medicare taxes for the equivalent of 40 quarters, you can still qualify for premium-free Part A. You can also qualify through a spouse’s work record if your own credits fall short.
Automatic Enrollment vs. Signing Up
If you’re already receiving Social Security benefits when you turn 65, you’ll be automatically enrolled in Part A. Your coverage starts the first day of the month you turn 65 (or the month before, if your birthday falls on the first of the month). You don’t need to do anything.
If you’re not yet collecting Social Security at 65, perhaps because you’re still working or you’re delaying benefits, you’ll need to actively sign up through the Social Security Administration. You can do this online, by phone, or at a local Social Security office. Your initial enrollment period spans seven months: the three months before your 65th birthday, your birthday month, and the three months after.
“Free” Doesn’t Mean No Costs
Even when Part A itself carries no monthly premium, it’s not completely without cost when you actually use it. In 2025, the hospital deductible is $1,676 per benefit period. A benefit period starts when you’re admitted to a hospital and ends 60 days after you’re discharged. If you’re hospitalized again after that 60-day window, you pay the deductible again.
For longer hospital stays, daily coinsurance kicks in. Days 1 through 60 are covered after you’ve paid the deductible with no additional daily charge. From day 61 through 90, you pay $419 per day. If your stay extends beyond 90 days, you draw from a lifetime reserve of 60 extra days at $838 per day. Once those lifetime reserve days are used, they don’t renew.
Many people purchase supplemental insurance (often called Medigap) or enroll in a Medicare Advantage plan specifically to help cover these out-of-pocket hospital costs. The premium-free status of Part A applies only to the monthly premium itself, not to what you owe when you receive care.