If you are worried about the cost of Medicare Part A, here is the reassuring part first: most people pay $0 for it. About 99% of Medicare beneficiaries owe no monthly Part A premium, because they or a spouse worked and paid Medicare taxes for at least 40 quarters, which is roughly 10 years. This guide explains who gets Part A premium-free, what it costs to buy in if you fall short, the rule that trips people up, and where to find help if the premium is more than you can manage.
Who gets Part A for free
For the large majority of people, Part A is premium-free, and it is earned through work. If you or your spouse paid Medicare payroll taxes for at least 40 quarters, which works out to about 10 years, you owe nothing each month for Part A. That is why roughly 99% of beneficiaries pay $0.
A few details decide whether the free coverage actually lands for you:
- Your own work record. Forty quarters of Medicare-covered employment qualifies you. Premium-free Part A based on a work record generally requires that you have also filed for Social Security or Railroad Retirement benefits.
- A spouse's record. If your own work history falls short, you can qualify on a spouse's 40-quarter record. In some cases this includes a divorced or deceased spouse's record.
- Disability before 65. Certain people who become eligible for Medicare before age 65 through disability also receive premium-free Part A.
If none of those describe you, you are not shut out of Part A. You can buy it, which the next section explains.
What it costs to buy Part A
If you do not qualify for premium-free Part A, you may be able to voluntarily buy it. The 2026 premium depends on how many quarters of Medicare-covered work you, or in some cases your spouse, have:
| Your work history | 2026 monthly Part A premium |
|---|---|
| 40 or more quarters (about 10 years), your own or a spouse's record | $0 (premium-free) |
| 30 to 39 quarters, or qualifying on a spouse's record | $311 |
| Fewer than 30 quarters | $565 |
| Note: premium-free is not cost-free | When you are hospitalized, Part A still charges a $1,736 inpatient deductible per benefit period in 2026 |
You may also qualify for the lower $311 rate based on a spouse's record, including in some cases a divorced or deceased spouse's record, even when your own record falls short. It is worth checking the higher of the two records before assuming you are stuck at the $565 rate.
One point the table makes that surprises people: premium-free does not mean cost-free. Even when you owe $0 a month, Part A charges cost-sharing when you actually use it, such as the $1,736 hospital deductible per benefit period in 2026. For the full picture of what Medicare costs once you start using it, see our guide to Medicare costs.
The rule that trips people up: you must also have Part B
This is the single requirement that catches the most people off guard. To buy premium Part A, you must also be enrolled in Medicare Part B. You cannot sign up for premium Part A on its own.
In practice, that means budgeting for both premiums together. If you are buying Part A at $311 or $565 a month, you also carry the standard monthly Part B premium on top of it. So when you weigh whether buying in makes sense, price out the pair, not just the Part A figure.
The late-enrollment penalty
If you have to pay a Part A premium and you do not buy it when you are first eligible, usually at age 65, a late-enrollment penalty can apply. The penalty raises your monthly Part A premium by 10%, and it applies for twice the number of years you could have had Part A but did not.
So if you went two years past your first eligibility before buying Part A, the 10% penalty would apply for four years. Note that this penalty exists only for people who must pay a Part A premium. If you qualify for premium-free Part A, it does not apply to you.
Because timing carries a cost, it pays to understand your enrollment windows before you decide to wait. Our guide to Medicare enrollment periods walks through when you can sign up and how the deadlines work.
If you cannot afford the premium
If you must pay a Part A premium and the cost is more than your budget allows, help exists. A Medicare Savings Program can pay the Part A premium for people with limited income and resources. These programs are run by state Medicaid agencies and can also cover other Medicare costs, depending on which program you qualify for.
If money is tight, this is the first place to look before you decide Part A is out of reach. Applying through your state Medicaid agency is the way to find out whether you qualify.
Frequently asked questions
Most people do not. About 99% of beneficiaries get premium-free Part A because they or a spouse worked and paid Medicare taxes for at least 40 quarters, which is roughly 10 years. If you do not have that work history, you can still get Part A by buying in, at $311 or $565 a month in 2026, depending on your number of quarters.
Yes. If your own record falls short of 40 quarters, you can qualify for premium-free Part A on a spouse's 40-quarter record. You may also qualify for the lower $311 buy-in rate based on a spouse's record, including in some cases a divorced or deceased spouse's record.
Yes. To buy premium Part A, you must also sign up for Medicare Part B. You cannot enroll in premium Part A by itself, so budget for both premiums together when you decide whether to buy in.
A Medicare Savings Program can pay the Part A premium for people with limited income and resources. These programs are administered by state Medicaid agencies. Applying through your state agency is the way to find out whether you qualify.
Learn More
- What Is Medicare? Parts A, B, C, and D explained
- What Medicare costs in 2026
- Medicare enrollment periods: when to sign up
- Medicare Savings Programs: help paying premiums
Find personalized help figuring out your Medicare Part A options at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.