Do You Have to Pay for Medicare Part A? How 'Premium-Free' Part A Works

Ask most people what Medicare Part A costs and they'll say "nothing." That's true for most, but not for everyone. Whether you pay depends on your work history, or your spouse's.

Who gets Part A without a premium

You qualify for premium-free Part A at 65 if you or your spouse worked long enough in jobs where you paid Medicare taxes. That's generally 40 quarters, about 10 years. The quarters don't need to be in a row.

You can also get premium-free Part A before 65 if you've been entitled to Social Security disability benefits for 24 months, or if you have end-stage renal disease (ESRD) or ALS and meet the conditions. Our guide to Medicare under 65 with a disability covers those paths.

Who pays, and how much

If you don't have enough quarters and can't qualify through a spouse, you can still buy Part A. You generally must also have Part B to buy it. The 2026 premium depends on your work history:

Medicare-covered work	2026 Part A premium
40 or more quarters	$0
30 to 39 quarters	$311 per month
Fewer than 30 quarters	$565 per month

CMS sets new amounts each fall for the following year.

Who tends to fall short? People who spent years working abroad, in jobs that didn't pay Medicare taxes, or out of the paid workforce. If you've moved to Texas from another country or after a career in such a job, it's worth checking your record early.

The spouse rule

Social Security says you can qualify for premium-free Part A at 65 based on your spouse's work, and that includes a living, deceased, or divorced spouse, as long as you meet the marriage requirements. Those requirements can be detailed, so confirm with Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

If you have to buy Part A

If you aren't eligible for premium-free Part A and don't buy it when you're first eligible, your monthly premium may go up 10%. You'd pay that higher premium for twice the number of years you could have had Part A but didn't sign up. For example, two years without it means four years of the higher premium. People who qualify for a Special Enrollment Period usually don't pay this penalty.

Part B has its own, separate late enrollment penalty.

Still working at 65? Watch your HSA

Premium-free Part A often makes sense even if you're still on a job-based plan, since there's no monthly bill. The big exception is a Health Savings Account (HSA). Social Security says you can't contribute to an HSA once your Part A or Part B coverage begins, and it recommends stopping contributions at least six months before you apply for Medicare to avoid a tax penalty.

If you or your spouse are still working, compare notes with your employer's benefits office before you sign up. Our guide to delaying Part B while you're still working covers the Part B side of that decision.

Signing up

If you already get Social Security benefits, you're automatically enrolled in Parts A and B starting the month you turn 65. If not, you sign up through Social Security, including through its online Medicare application. Our step-by-step guide to signing up for Parts A and B in Texas has the details.

Help with Medicare costs in Texas

If your income and savings are limited, Texas's Medicare Savings Programs, run by Texas Health and Human Services, may help pay Medicare costs. The Qualified Medicare Beneficiary (QMB) program, for example, can help with Medicare premiums, deductibles, and coinsurance. Income and resource limits change each year, so call Texas HICAP at 1-800-252-9240 for current figures, or read our guide to Part B premium help in Texas.