Who Pays a Medicare Part A Premium (and Who Doesn’t)?
When enrolling in Medicare, many beneficiaries are relieved to learn that Medicare Part A — which covers hospital stays and inpatient care — is often premium-free. However, not everyone qualifies for premium-free Part A, and some enrollees may have to pay a monthly premium.
Here’s a breakdown of who pays for Part A, who doesn’t, and what you can do if you need to purchase coverage.
🏥 1. What Does Medicare Part A Cover?
Medicare Part A provides coverage for:
✅ Inpatient Hospital Care: Covers semi-private rooms, meals, and necessary medical services during a hospital stay.
✅ Skilled Nursing Facility (SNF) Care: Covers short-term rehabilitation following a hospital stay.
✅ Hospice Care: Provides end-of-life care for terminally ill patients.
✅ Home Health Care: Includes limited in-home care services after a hospital stay.
While most beneficiaries receive Part A at no cost, some must pay a monthly premium.
💸 2. Who Gets Medicare Part A for Free?
✅ You or Your Spouse Worked 10 Years or More (40 Quarters)
If you or your spouse paid Medicare payroll taxes for at least 10 years (40 quarters), you qualify for premium-free Part A. This is true even if:
You’re no longer working.
You’re divorced but were married to your spouse for at least 10 years.
✅ Individuals Receiving Social Security or Railroad Retirement Benefits
If you’re already receiving Social Security or Railroad Retirement benefits when you turn 65, you’ll be automatically enrolled in Medicare Part A and will not pay a premium.
✅ Individuals Eligible for Social Security Disability Insurance (SSDI)
If you’ve received SSDI for 24 months, you automatically qualify for premium-free Part A, regardless of age.
📈 3. Who Pays a Part A Premium?
You may have to pay for Part A if you don’t meet the requirements for premium-free coverage.
✅ You or Your Spouse Worked Less Than 10 Years (40 Quarters)
If you or your spouse did not work long enough to qualify for premium-free Part A, you’ll need to pay a monthly premium.
In 2025, the Part A premium is:
$518/month if you worked less than 30 quarters.
$285/month if you worked between 30 and 39 quarters.
$0/month if you worked 40 or more quarters.
📚 4. Can You Still Get Medicare If You Have to Pay for Part A?
✅ Yes, You Can Purchase Part A
Even if you don’t qualify for premium-free Part A, you can still enroll, but you’ll pay a monthly premium.
💡 Important: If you delay Part A enrollment and do not have other creditable coverage, you may face a late enrollment penalty that increases your premium by 10% for twice the number of years you delayed.
⚠️ 5. Part A Late Enrollment Penalty
If you don’t enroll in Part A when you’re first eligible and later decide to sign up, you’ll pay a penalty:
10% penalty on your monthly premium.
Penalty lasts twice the number of years you delayed enrollment.
For example:
If you delayed Part A for 2 years, you’ll pay the higher premium for 4 years.
🏦 6. How to Qualify for Premium-Free Part A if You Don’t Meet the Requirements
If you don’t qualify for free Part A based on your work history:
✅ Spouse’s Work Record: You may qualify based on your spouse’s or ex-spouse’s work history if they meet the 40-quarter requirement.
✅ Qualify Later: If you continue working and reach 40 quarters of employment after age 65, you can stop paying the Part A premium once you qualify.
✅ Medicaid Assistance: If you have limited income and assets, Medicaid may help cover your Part A premium.
🤔 7. Should You Pay for Part A If You Don’t Qualify for Free Coverage?
✅ Consider Buying Part A If:
You need hospital coverage and don’t qualify through work history.
You’re already enrolled in Part B and want comprehensive Medicare benefits.
✅ Explore Alternatives:
If you qualify for Medicaid, it may cover Part A and other healthcare costs.
Evaluate whether a Medicare Advantage Plan offers a better solution if you’re paying for Part A.
📢 Final Thoughts: Understanding Part A Costs Can Save You Money
Knowing whether you qualify for premium-free Part A or if you’ll need to pay a premium can help you plan for future healthcare costs. If you’re unsure about your eligibility or need guidance on managing Medicare expenses, Riverside Insurance Professionals is here to help.
📞 Call 573-535-6044 today to schedule a consultation and explore your best Medicare options!
Disclaimer:
This content is for informational and educational purposes only and is not intended as legal, financial, or medical advice. While we strive to provide accurate and up-to-date information, Medicare rules, premiums, and guidelines may change. For the most current information, please visit the official Medicare website (www.medicare.gov) or contact a licensed Medicare professional.
Riverside Insurance Professionals is not affiliated with or endorsed by the U.S. government or the federal Medicare program.