Is Medicare Part A Free? Who Pays Premium & Who Doesn't

In 2026, Medicare Part A will be premium free for about 99% of Medicare beneficiaries, but only because of the history of your work (or your spouse's). Medicare taxes are paid for a minimum of 10 years (40 quarters) of covered work done by you or your spouse, the premium for Medicare Part A in 2026 is $0 a month. Premiums for Part A will increase to $311 per month for those with 30 to 39 quarters of Medicare coverage for 2026 (from $285 in 2025). The lowest number of quarters of qualifying work is less than 30 quarters, which means that the full premium will be $565 in 2026 (up from $518 in 2025). While premium-free Part A is free, the coverage is not actually "free" because you still must pay deductibles and coinsurance when you use services. The 2026 Part A deductible is $1,736 per benefit period, hospital coinsurance is $434 per day while the reserve days for Part A are $868 per day.

This guide will help you understand who is eligible for Medicare Part A premium-free, work history requirements, eligibility by spouse and special conditions, and the cost if you don't qualify. The data are from Medicare.gov, CMS and the Social Security Administration. 

The 40-quarter rule explained

Premium-free Medicare Part A is based on the 40-quarter guideline. A three-month period is called a “quarter” in Social Security jargon and there are 4 quarters in each calendar year. In 2026 you can get up to 4 credits per year ($1,810 worth of covered earnings) and 1 credit for every $1,810 of covered earnings.

The 40 quarters required are usually accumulated over a 10-year period of working in which you have been paying Medicare payroll taxes (the 1.45% Medicare deducted from each paycheck). Self-employed persons withhold and pay both the employer and employee contributions into the self-employment tax (total of 2.9%). The majority of wage- and salary-based occupations qualify for this requirement, such as those involving W-2 employment, self-employment, and some federal, state, and local government jobs under Medicare Qualified Government Employment (MQGE) provisions.

The 40 quarters do NOT have to be consecutive. Can be compounded throughout one's working life. A person who has worked for many years but not consistently each year is still considered to have covered employment if his or her total is 40 quarters. The Social Security Administration will keep track of your quarters from your W-2s and self-employment tax returns.

To see how many quarters you have, create an account at ssa.gov/myaccount. Your Social Security statement displays your earnings history and the number of credits you've earned.

If you need more general information about Medicare, read our overview of Medicare parts. 

Qualifying through your spouse

Because many beneficiaries are eligible for premium-free Part A based on their spouse's work history instead of their own, they are not required to purchase premium-free coverage.Many beneficiaries will have premium free coverage due to their spouse's work history, and won't need to buy premium free coverage. It's especially important for those who have not had enough direct work experience to be eligible for Medicare, were employed in a job that is not covered by Medicare, or did not work in a job that covered the cost of Medicare.

If your spouse has 40+ quarters, and you are 65+, you can qualify for premium-free Part A based on a spouse's work history. However, you will need to use the record if the spouse is 62 or older. You can qualify immediately if your spouse is already getting Medicare.

If you have been divorced from the spouse for a period of 10 years or more, and you have not remarried, the divorcee's work history can be used for qualification. This is true even if the ex-spouse is living or receiving Medicare. The timeliness is set for 10 years.

If the marriage was at least 9 months long, surviving spouses may be eligible based on the deceased spouse's work history (there are some exceptions for the death or accident while serving in the military service). Widows and widowers don't lose this eligibility if they remarry after age 60.

In a few cases you might be eligible based on a parent's work history (if you became disabled before age 22) or a child's work history (if you're taking care of an entitled disabled child). There are other less common pathways for specific family situations.

Check our guide on Medicare enrollment periods for enrollment timing. 

Premium-free Part A through medical conditions

Some medical conditions may be eligible to have premium-free Part A, even if there is no work history involved.

If you have End-Stage Renal Disease (ESRD) and must do dialysis or receive a kidney transplant, you are eligible for Medicare at any age. Usually coverage starts at the fourth month after dialysis begins or kidney transplant. ESRD beneficiaries are exempt from the work history requirement. Only 6 quarters of Medicare covered work in the 13 quarters prior to kidney failure are required.

Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) automatically entitles patients to Medicare coverage without a waiting period. There is no "waiting period" for Social Security Disability benefits for ALS. Coverage begins the month that Social Security Disability Insurance begins.

Medicare eligibility begins for Social Security Disability Insurance (SSDI) recipients two years after SSDI benefits start. The vast majority of SSDI beneficiaries get premium-free Part A.

If you're looking for Medicare for SSDI, Medicare for ESRD, and Medicare for ALS guidance, check out our special guides on these conditions.

What it costs if you don't qualify for premium-free Part A

If you don't qualify for premium-free Part A through your own work, your spouse, or special conditions, you can still buy Part A coverage. The 2026 premium structure has two tiers based on your quarters of coverage.

With 30-39 quarters of Medicare-covered employment, your 2026 monthly premium is $311 (up from $285 in 2025). This pro-rated premium recognizes partial qualification while still requiring contribution.

With fewer than 30 quarters, the full Part A premium for 2026 is $565 per month (up from $518 in 2025). This is the highest tier, applied when minimal Medicare contribution has occurred.

To buy Part A coverage, you must also have or be eligible for Medicare Part B, which costs $202.90/month standard in 2026. You must be a U.S. citizen or have been a legal resident with a green card for at least 5 consecutive years.

The annual cost of buying Part A is substantial. $311/month equals $3,732 per year. $565/month equals $6,780 per year. Adding Part B at $202.90/month adds another $2,434.80 annually. For someone paying the full Part A premium plus standard Part B, the total annual cost is approximately $9,215 before any deductibles or coinsurance.

Late enrollment penalty

If you don't qualify for premium-free Part A and you delay enrollment when first eligible, you face a Part A late enrollment penalty. The penalty is 10% added to your monthly premium for twice the number of years you could have had Part A but didn't enroll.

For example, if you waited 4 years to enroll in Part A, your premium would be 10% higher for 8 years. After 8 years, the penalty drops off. The penalty applies whether you're paying $311 or $565 monthly.

You can continue working to try to reach 40 quarters. Once you reach 40 quarters of covered employment, Part A reverts to premium-free status. This makes continuing to work valuable even past age 65 for those close to the 40-quarter threshold.

For working past 65, see our Medicare and employer insurance guide.

What Part A actually covers

Even with premium-free Part A, you don't get truly "free" healthcare because Part A includes deductibles and coinsurance for services used.

The 2026 Medicare Part A deductible is $1,736 per benefit period. A benefit period starts when you're admitted as an inpatient and ends after 60 days without inpatient care. You can have multiple benefit periods per year.

Hospital coinsurance is $0 for days 1-60 of each benefit period (after the deductible), $434 per day for days 61-90, and $868 per day for the 60 lifetime reserve days (used only once in your lifetime). After exhausting lifetime reserve days, you pay all costs.

Skilled nursing facility coverage under Part A has its own cost structure: $0 for days 1-20, $217 per day for days 21-100, and no Medicare coverage after day 100.

Hospice care has no premium or deductible. You may pay up to $5 per outpatient prescription drug for symptom relief and 5% coinsurance for inpatient respite care. See our hospice coverage guide for details.

Home health care under Part A or Part B is fully covered when eligibility requirements are met. See our Medicare home health care and home health qualification guides.