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.
Is Medicare Part A Free?
For most people, yes. Part A is premium-free for the large majority of beneficiaries, 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.Centers for Medicare & Medicaid Services. (n.d.). Costs. medicare.gov. Retrieved Jul 24, 2026, from https://www.medicare.gov/basics/costs/medicare-costs
A few details decide whether the free coverage actually lands for you:
- Your own work record. Forty quarters of Medicare-covered employment qualifies you. Social Security is the agency that determines whether your record reaches 40 quarters.
- A spouse's record. If your own work history falls short, you can qualify on a spouse's 40-quarter 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 Medicare Part A costs when it is not free
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 work 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.Centers for Medicare & Medicaid Services. (n.d.). Costs. medicare.gov. Retrieved Jul 24, 2026, from https://www.medicare.gov/basics/costs/medicare-costs
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.Centers for Medicare & Medicaid Services. (2026). 2026 Medicare Parts A & B Premiums and Deductibles. cms.gov. Retrieved Aug 7, 2026, from https://www.cms.gov/newsroom/fact-sheets/2026-medicare-parts-b-premiums-deductibles
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.Centers for Medicare & Medicaid Services. (n.d.). Costs. medicare.gov. Retrieved Jul 24, 2026, from https://www.medicare.gov/basics/costs/medicare-costs
How to buy Part A if you do not qualify
Medicare enrollment is handled by the Social Security Administration, not by Medicare itself, so buying premium Part A means signing up through Social Security. Here is how to do it.Centers for Medicare & Medicaid Services. (n.d.). Costs. medicare.gov. Retrieved Jul 24, 2026, from https://www.medicare.gov/basics/costs/medicare-costs,Centers for Medicare & Medicaid Services. (n.d.). How do I sign up for Medicare?. medicare.gov. Retrieved Jul 15, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/how-do-i-sign-up-for-medicare
Confirm you do not qualify premium-free
Before you pay for anything, have Social Security check your work record and your spouse's record. If either of you reaches 40 quarters, your Part A is free and there is nothing to buy.
Plan to enroll in Part B at the same time
You cannot buy premium Part A on its own, so you will sign up for Part B alongside it and carry both monthly premiums.
Sign up through Social Security
Contact the Social Security Administration at ssa.gov/medicare/sign-up or 1-800-772-1213, or visit your local Social Security office, to enroll in premium Part A and Part B.
Timing decides whether you also owe a penalty. Most people sign up during their Initial Enrollment Period, the seven-month window that starts three months before the month you turn 65 and ends three months after. If you miss that window, you generally have to wait for the General Enrollment Period, January 1 through March 31 each year, and your coverage starts the first day of the month after you enroll. The main exception is working past 65: if you (or your spouse) have group health coverage based on that current employment, a Special Enrollment Period lets you take premium Part A and Part B later without a penalty. That window runs eight months, counted from the month that job or coverage ends, whichever comes first. Not every job-based plan counts: Medicare gives this guidance for group health insurance that is available to everyone at the company, and tells people who are self-employed, or whose plan is not available to everyone at the company, to ask their insurance provider whether it is employer group health plan coverage as the IRS defines it, and to sign up at 65 if it is not. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD). Waiting past your first eligibility is also what triggers the late-enrollment penalty covered next, so if you plan to buy in, it pays to enroll on time. Our guide to Medicare enrollment periods walks through each window in detail.Centers for Medicare & Medicaid Services. (n.d.). Open Enrollment. medicare.gov. Retrieved Sep 2, 2026, from https://www.medicare.gov/health-drug-plans/open-enrollment,Centers for Medicare & Medicaid Services. (n.d.). When does Medicare coverage start?. medicare.gov. Retrieved Aug 9, 2026, from https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start
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. Your monthly Part A premium may go up 10%, and you pay that penalty for twice the number of years you delayed. Usually no penalty applies if you meet the conditions that let you sign up for Part A during a Special Enrollment Period.Centers for Medicare & Medicaid Services. (n.d.). Avoid late enrollment penalties. medicare.gov. Retrieved Jul 15, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
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.Centers for Medicare & Medicaid Services. (n.d.). Avoid late enrollment penalties. medicare.gov. Retrieved Jul 15, 2026, from https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
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.Centers for Medicare & Medicaid Services. (n.d.). Costs. medicare.gov. Retrieved Jul 24, 2026, from https://www.medicare.gov/basics/costs/medicare-costs
Frequently Asked Questions
Do I have to pay for Medicare Part A?
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.
Can I get Part A on my spouse's work record?
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 work record.
Do I have to enroll in Part B to buy Part A?
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.
How do I sign up to buy Part A?
You enroll through the Social Security Administration, not Medicare. Contact Social Security at ssa.gov/medicare/sign-up or 1-800-772-1213, and sign up for Part B at the same time, since you cannot buy premium Part A on its own. Enrolling during your Initial Enrollment Period around age 65 keeps you clear of the late-enrollment penalty.
What if I cannot afford the Part A premium?
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
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.