Most people pay nothing for Medicare Part A. If you or your spouse worked at least 40 quarters (about 10 years) in jobs that paid Medicare taxes, Part A is premium-free. If you have 30 to 39 quarters, Part A costs $311 a month in 2026. If you have fewer than 30 quarters, it costs $565 a month. CMS says about 99% of people on Medicare pay no Part A premium. The 2027 amounts have not been announced yet. CMS usually publishes them in mid-November, and until January 1, 2027, the 2026 figures below are the ones in effect.
The people who do pay are mostly immigrants who came to the U.S. later in life, spouses whose partner is not yet 62, and some long-time government workers whose jobs did not pay into Medicare. Many of them also qualify for a state program that pays the Part A premium for them, which is covered further down.
Medicare Part A Premium 2026 by Work History
| Your work history (yours or your spouse's) | Monthly Part A premium, 2026 | Yearly cost, 2026 |
|---|
| 40 or more quarters | $0 | $0 |
| 30 to 39 quarters | $311 | $3,732 |
| Fewer than 30 quarters | $565 | $6,780 |
Source: CMS, "2026 Medicare Parts A & B Premiums and Deductibles" fact sheet (November 14, 2025), and Medicare.gov's 2026 costs page.
If you buy Part A, you must also enroll in Part B. The standard Part B premium in 2026 is $202.90 a month. So a person with fewer than 30 quarters pays $767.90 a month for Parts A and B together in 2026, before any late penalty.
What Counts as a Quarter
A "quarter" is the same thing Social Security calls a work credit. You earn one for a set amount of earnings in jobs that pay Medicare tax, up to 4 per year.
| Year | Earnings needed for one quarter | Most you can earn per year |
|---|
| 2026 | $1,890 | 4 quarters |
| 2027 (announced by SSA) | $1,970 | 4 quarters |
Source: SSA 2027 COLA fact sheet.
Quarters do not need to be in a row, and they can come from any year. That matters if you are close. Someone at 36 quarters who works one more year at modest pay can reach 40 and drop from $311 a month to $0. Someone at 28 quarters who earns 2 more drops from $565 to $311.
You can check your count on your Social Security statement at ssa.gov/myaccount, or by calling Social Security at 1-800-772-1213.
Getting Premium-Free Part A Through a Spouse
You do not need your own 40 quarters if a spouse or former spouse has them. Social Security generally looks at these situations:
| Your situation | General rule |
|---|
| Currently married | Married at least 1 year, and your spouse is at least 62 and has 40 quarters |
| Divorced | The marriage lasted at least 10 years, you are currently unmarried, and your ex-spouse is at least 62 with 40 quarters |
| Widowed | Married at least 9 months before your spouse died (with some exceptions), and you are not remarried, or remarried after age 60 |
The age 62 rule catches many couples. If you turn 65 before your spouse turns 62, you may have to pay the Part A premium until your spouse's 62nd birthday, then it can switch to $0. Ask Social Security to recheck your premium the month your spouse turns 62.
Premium-Free Part A Before 65
Some people get Part A early, and it is premium-free for them:
- People who have received Social Security disability (SSDI) or certain Railroad Retirement disability benefits for 24 months
- People with ALS, from the month SSDI disability benefits start
- People with end-stage renal disease (permanent kidney failure) who meet the work requirements
Medicare.gov puts it simply: "If you get Medicare earlier than age 65, you won't pay a Part A premium."
There is one exception. If you return to work and your SSDI stops, premium-free Part A continues for an extended period. When that ends, you can keep Part A by paying the premium. A program called QDWI (below) can pay it for working people with disabilities.
Who Actually Ends Up Paying for Part A
People who pay a Part A premium usually fall into one of these groups:
- Immigrants who arrived later in life. A green card holder who came to the U.S. at 55 may have fewer than 40 quarters at 65. To buy Part A, you must be 65 or older and either a U.S. citizen or a permanent resident who has lived in the U.S. for 5 continuous years before you apply.
- Spouses who did not work outside the home, when the working spouse is under 62 or does not have 40 quarters.
- Some state and local government retirees. Some workers hired before April 1986 were in jobs that did not pay Medicare tax. Their pension work may not count toward the 40 quarters.
- People who worked mostly abroad, unless a totalization agreement or other earnings fill the gap.
- People with disabilities who went back to work and used up their extended Medicare coverage.
If you are in groups 1 or 2, you may also qualify for help paying the premium, especially if your income is modest.
Rules for Buying Part A
Premium Part A is not automatic. Social Security lists these conditions:
- You are 65 or older (or a working person with a disability who lost premium-free Part A)
- You live in the U.S. and are a citizen, or a permanent resident who has lived here 5 continuous years before you apply
- You also enroll in Part B, or already have it
- You sign up during an enrollment period
| Enrollment period | When | Notes |
|---|
| Initial Enrollment Period | 7 months: 3 months before the month you turn 65, that month, and 3 months after | Signing up early avoids gaps |
| General Enrollment Period | January 1 to March 31 each year | Coverage starts the month after you sign up |
| Special Enrollment Period | Usually within 8 months after job-based coverage (yours or your spouse's) ends | Only for coverage from current work |
You apply through Social Security, online at ssa.gov, by phone, or at a local office.
The Part A Late Enrollment Penalty
If you have to buy Part A and do not sign up when you first can, your monthly premium may go up 10%. Medicare.gov says you pay the higher premium for twice the number of years you did not sign up.
Example using 2026 figures: you have fewer than 30 quarters and wait 2 years to sign up. Your premium is $565 plus 10% ($56.50), or $621.50 a month, for 4 years. After those 4 years, it drops back to the regular premium.
Unlike the Part B penalty, the Part A penalty ends. People with premium-free Part A never owe a Part A penalty. More detail is in our guide to the Medicare late enrollment penalty.
Programs That Pay the Part A Premium
Two Medicare Savings Programs (MSPs) pay the Part A premium. Your state Medicaid office runs them.
| Program | Pays | Income limit, single | Income limit, couple | Resource limit, single | Resource limit, couple |
|---|
| QMB (Qualified Medicare Beneficiary) | Part A premium (if you do not have premium-free Part A), Part B premium, deductibles, coinsurance, copays | $1,350 a month | $1,824 a month | $9,950 | $14,910 |
| QDWI (Qualified Disabled and Working Individuals) | Part A premium only | $5,405 a month | $7,299 a month | $4,000 | $6,000 |
Source: Medicare.gov Medicare Savings Programs page, 2026 limits. The income limits are higher in Alaska and Hawaii, and some states use higher limits or skip the resource test. The 2027 resource limits have not been published yet.
For someone with fewer than 30 quarters, QMB is worth $6,780 a year in Part A premiums alone, plus $2,434.80 a year in Part B premiums, plus the deductibles and coinsurance. QMB also bars Medicare providers from billing you for covered cost sharing. Our guides to QMB income limits and all Medicare Savings Programs cover the details.
Because MSPs are Medicaid programs, they follow Medicaid's immigrant rules. Most green card holders must wait 5 years from the date they got their status, and since October 1, 2026, refugees, asylees and parolees without a green card generally no longer qualify for Medicaid programs.
Part A Buy-In States vs. Group Payer States
If you qualify for QMB but cannot afford to enroll in Part A first, you can apply for Part A "conditionally" at Social Security. You only get Part A if the state approves QMB and agrees to pay the premium.
Where you live decides when you can do this. Social Security's operations manual (POMS HI 00801.140, October 2026) says:
- Part A buy-in states (most states and DC): you can conditionally enroll in Part A and enroll in Part B at any time of year, and late penalties do not apply.
- Group payer states: you must use an enrollment period, usually the General Enrollment Period (January 1 to March 31). The group payer states are Alabama, Arizona, Colorado, Illinois, Kansas, Kentucky, Missouri, Nebraska, New Jersey, New Mexico, South Carolina, Utah and Virginia.
If you live in a group payer state and are reading this in late 2026, January 1, 2027 is the next time you can start a conditional Part A application.
How to Find Out What You Will Pay, Step by Step
- Check your quarters. Log in to ssa.gov/myaccount and look at your earnings record, or call 1-800-772-1213. Ask about your spouse's or ex-spouse's record too.
- Count the months to 65. Your Initial Enrollment Period starts 3 months before your 65th birthday month.
- If you have 40 quarters through yourself or a spouse: sign up for Medicare at ssa.gov. Part A costs $0.
- If you have fewer than 40: compare your monthly income with the QMB limit ($1,350 single, $1,824 couple, in 2026). If you are under or close to it, apply for QMB at your state Medicaid office and ask Social Security about conditional Part A enrollment.
- If your income is too high for QMB: decide whether to buy Part A. Not buying it when first eligible can mean a 10% penalty later. Some people with job-based coverage from current work can delay without a penalty.
- Keep working if you are close. Each $1,890 of Medicare-taxed earnings in 2026 ($1,970 in 2027) adds a quarter, up to 4 a year.
Other Part A Costs in 2026
The premium is only one part of what Part A costs. Even with premium-free Part A, you pay these when you use hospital or skilled nursing care:
| Part A cost | 2026 amount |
|---|
| Inpatient hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61 to 90 | $434 a day |
| Lifetime reserve days | $868 a day |
| Skilled nursing facility coinsurance, days 21 to 100 | $217 a day |
Source: CMS 2026 Parts A & B fact sheet. For how Part A and Part B split coverage, see Medicare Part A vs Part B. For deductibles across both parts, see Medicare deductibles in 2026.
What Changes in 2027
CMS has not published the 2027 Part A premiums, Part A deductible, or Part B premium as of November 4, 2026. CMS usually releases them in mid-November, and they take effect January 1, 2027. Until then, any 2027 Part A premium you see is a projection, not an official figure. Our Part A deductible 2027 projections page explains how those projections are made and labels them as estimates.
Two things for 2027 are already set. The earnings needed for one quarter rise to $1,970 (SSA), and the work-history rules for premium-free Part A do not change: 40 quarters is still $0, and 30 to 39 still gets the reduced premium.
Frequently Asked Questions
Do you have to pay for Medicare Part A?
Most people do not. If you or your spouse have 40 quarters of Medicare-taxed work, Part A is premium-free. About 99% of people on Medicare pay no Part A premium, according to CMS. You still pay the deductible and coinsurance when you use hospital care.
How much is Medicare Part A if you did not work 40 quarters?
In 2026, it is $311 a month with 30 to 39 quarters and $565 a month with fewer than 30. You must also enroll in Part B ($202.90 a month in 2026). The 2027 amounts come out from CMS in the fall, usually mid-November.
What is the Medicare Part A premium for 2027?
CMS has not announced it as of November 4, 2026. The 2026 figures ($0, $311 or $565) stay in effect through December 31, 2026.
Can I get premium-free Part A from my spouse's work record?
Yes, if your spouse has 40 quarters and is at least 62, and you have been married at least 1 year. Divorced people can use an ex-spouse's record if the marriage lasted 10 years and they have not remarried. Widows and widowers have their own rules.
Can a green card holder get Medicare Part A?
Yes. With 40 quarters of U.S. work (or a spouse's), Part A is premium-free. Without them, a permanent resident who is 65 or older and has lived in the U.S. for 5 continuous years can buy Part A, along with Part B.
Does Medicaid pay the Part A premium?
The QMB program, which your state Medicaid office runs, pays the Part A premium for people with income up to about $1,350 a month (single) in 2026. QDWI pays it for working people with disabilities who lost premium-free Part A. Full Medicaid alone does not always mean the state pays Part A, so ask about QMB by name.
Can I buy Part A without Part B?
No. If you have to pay for Part A, you must also enroll in Part B. People with premium-free Part A can choose to delay Part B in some cases, such as when they have job-based coverage from current work.
Does the Part A late penalty last forever?
No. You pay the extra 10% for twice the number of years you could have had Part A but did not sign up. A 2-year delay means 4 years of the higher premium.
