Most people pay nothing for Medicare Part A. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), Part A is premium-free. But if you don’t meet that work history threshold, you will pay a monthly premium, and it can be substantial.
Who Gets Premium-Free Part A
You qualify for premium-free Part A if you’ve earned at least 40 quarters of work credits through Social Security, the Railroad Retirement Board, or certain government employment. A “quarter” roughly equals three months of work where you paid Medicare taxes, so 40 quarters translates to about 10 years of employment over your lifetime. These don’t need to be consecutive.
You can also qualify based on someone else’s work record. If your spouse, parent, or deceased spouse earned the required 40 quarters, you’re eligible for premium-free Part A through their record. This is especially relevant for people who spent years out of the workforce as caregivers or who immigrated to the U.S. later in life and married someone with a full work history.
What the Premium Costs If You Must Pay
If you have between 30 and 39 quarters of work credits, you pay a reduced premium. If you have fewer than 30 quarters, you pay the full premium. For 2026, the exact amounts are updated annually by CMS each fall, but the full premium has historically run over $500 per month, making it one of the more expensive components of Medicare for those who must buy in.
This premium covers hospital insurance: inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Even with Part A coverage, you still owe a per-benefit-period deductible when you’re admitted to the hospital. That deductible rises to $1,736 in 2026 and covers your share of costs for the first 60 days of an inpatient stay.
Late Enrollment Penalties
If you’re required to pay a Part A premium and don’t sign up when you’re first eligible, a penalty applies. Your monthly premium increases by 10%, and 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 10% surcharge for four years.
This penalty only applies to people who must purchase Part A. If you qualify for premium-free Part A, there’s no penalty for late enrollment, though you may miss out on coverage during the gap.
Help Paying the Premium
If you have to pay the Part A premium and your income is limited, state Medicare Savings Programs can cover some or all of the cost.
- Qualified Medicare Beneficiary (QMB) Program: Pays your Part A premium (plus Part B premiums, deductibles, and copayments). For 2026, you may qualify with monthly income up to $1,350 as an individual or $1,824 as a married couple, and resources below $9,950 (individual) or $14,910 (couple).
- Qualified Disabled and Working Individual (QDWI) Program: Covers Part A premiums only. This is designed for people with disabilities who lost premium-free Part A because they returned to work. Income limits are higher: up to $5,405 per month for an individual or $7,299 for a couple in 2026.
Income limits are slightly higher in Alaska and Hawaii, and some states set their own thresholds above the federal minimums. Your state Medicaid office handles applications for these programs.
How to Check Your Work Credits
The fastest way to find out whether you’ll owe a premium is to check your Social Security statement. You can create an account at ssa.gov and view your earnings record, which shows how many quarters of coverage you’ve accumulated. If you’re close to 40 but not quite there, even a few more quarters of work before you turn 65 could save you hundreds of dollars a month in premiums for the rest of your time on Medicare.
If you’re enrolling based on a spouse’s record, you’ll need to provide documentation of the marriage. For divorced spouses, you generally need to have been married for at least 10 years and currently be unmarried to use an ex-spouse’s work history.