If a person has never worked, they may qualify for premium-free Medicare Part A in some cases. If someone does not qualify, they may get Part A by paying the premium.
In general, most people do not pay any monthly premium for Medicare Part A because the taxes they have paid through work contribute to their eligibility for coverage.
However, there is a minimum contribution amount equal to at least 40 quarters throughout a person’s working years.
This article discusses how a person can get Medicare Part A without paying the premium and how they may qualify for the coverage. It also describes how to get Part A while paying the premium, plus enrollment periods and costs.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
A person who has not worked may qualify for premium-free Medicare in one of two ways: their spouse has enough work history to qualify or if a person has certain disabilities or medical conditions.
Spousal eligibility
A married person may qualify for Medicare Part A and not have to pay the premium because their eligibility is dependent on a spouse’s work history.
In general, a person needs a minimum of 40 calendar quarters of work to be eligible for premium-free Medicare Part A. However, if they do not meet that requirement, their spouse’s work record may allow them to get coverage without paying the premium.
If a person’s spouse meets the minimum requirement, this means the individual with insufficient quarters of work may be eligible when they turn 65 years of age.
In addition, a non-working spouse may get Medicare Part A without having to pay a premium for the following reasons:
- The person’s spouse is eligible for Social Security benefits. They must be married for a minimum of 12 months before applying.
- The person is divorced from their spouse, and the former spouse is eligible for Social Security benefits. They must have been married for at least 10 years and divorced for at least 2 years.
- The person is widowed but was married for at least 9 months before the spouse died. The person must now be single.
Learn more about Medicare spouse coverage.
Disabilities or medical conditions
If a person has certain disabilities or medical conditions, they may be able to get premium-free Medicare Part A before the age of 65 years. A person will automatically get Medicare once they have received disability benefits for 24 months or earlier if they turn 65 before 24 months have passed.
A person with end stage renal disease may be eligible for premium-free Part A if they also meet one of the following conditions:
- They must also be on dialysis or have received a kidney transplant.
- They qualify for Railroad Retirement Board benefits.
- They qualify for Social Security retirement benefits.
- They have a parent or spouse eligible for Social Security retirement benefits.
A person with amyotrophic lateral sclerosis (ALS) is eligible for Part A coverage when they first get disability benefits.
Individuals can use this tool to check if they are eligible and the cost of premiums.
Learn more about Medicare and disability.
If a person is not eligible for premium-free Part A, they may be able to buy Part A.
However, they will need to pay the monthly premium, which is either $278 or $505. The premium amount depends on how many quarters a person has paid taxes.
If a person buys Part A, they may also need to get Part B, which is medical insurance. The basic premium for Part B in 2024 is $174.70.
If a person is receiving Social Security benefits, they will have automatic enrollment in Original Medicare Part A and Part B when they turn 65.
If someone needs to enroll, there are different Medicare enrollment periods.
Initial Enrollment Period
Medicare has an Initial Enrollment Period (IEP) of 7 months. During that time, a person can enroll for Medicare Part A and Part B:
- during the 3 months before the month a person turns 65
- during the month a person turns 65 — their birthday month
- before the end of 3 months after the month in which a person turns 65
Late enrollment penalties
If a person does not enroll in Original Medicare during the IEP, they can do so during the General Enrollment Period, which is from January 1 to March 31 each year. However, they may have to pay penalties.
If a person chooses to buy Part A, the premium will be either $278 or $505 a month, depending on the amount of taxes they have paid.
There may also be deductibles and coinsurance.
If a person chooses to buy Part A, they must also have Part B, which covers medically necessary and preventive services. The Part B monthly premium can vary depending on income, and individuals must also pay deductibles and coinsurance.
Learn more about Medicare costs.
While most people do not pay a monthly premium for Medicare Part A, a person who has never worked may be eligible in certain circumstances to get premium-free Part A. People may be eligible for Medicare if they have certain disabilities or if their spouse has Medicare.
In some cases, a person who has never worked may have to buy Medicare Part A and Part B. They need to ensure they are aware of premiums, deductibles, coinsurance, and enrollment deadlines.