Medicare Part A Premium: Work Credits and Who Pays Nothing

Most people pay no monthly premium for Medicare Part A because they or a spouse earned at least 40 work credits. That is about 10 years of work paying Medicare taxes. With fewer credits, you can still get Part A by paying a monthly premium.

Key takeaways

• Most people get Part A with no monthly premium once they or a spouse have 40 work credits.
• You earn credits by working and paying Social Security and Medicare taxes, up to 4 credits a year.
• A current, former or late spouse's work record may count for you.
• With fewer than 40 credits, you can buy Part A. The premium depends on how many credits you have.
• No premium does not mean no cost. The 2026 Part A hospital deductible is $1,736 per benefit period.

What does Part A pay for?

Part A is Medicare's hospital insurance. It helps pay for inpatient hospital stays, care in a skilled nursing facility after a qualifying hospital stay, hospice care and some home health care.

Part A is one piece of Original Medicare. Part B covers doctor visits and outpatient care, and it has its own premium. For a full picture of each part, see Medicare Parts A, B, C, D: What Each Covers.

This article answers one question. Will you pay a monthly premium for Part A, and why?

How are Medicare work credits earned?

A work credit is a unit Social Security uses to track your work history. You earn credits when you work in a job and pay Social Security and Medicare taxes. Self-employed work counts too, when you pay those taxes on your earnings.

You can earn up to 4 credits each year. Each credit takes a set amount of earnings, and Social Security raises that amount most years. Once you earn a credit, it stays on your record, even if you stop working.

So 40 credits takes at least 10 years of work. The years do not have to be in a row. Part-time jobs and jobs from long ago all add up.

Who pays no Part A premium?

You can usually get Part A with no monthly premium if one of these is true:

• You have 40 or more credits from your own work.
• Your spouse has 40 or more credits, and you meet Social Security's marriage rules.
• You get, or can get, retirement benefits from Social Security or the Railroad Retirement Board (the agency that pays benefits to railroad workers).
• You are under 65 and get disability benefits from Social Security or the Railroad Retirement Board for the required length of time.
• You have ESRD (end-stage renal disease, which is permanent kidney failure needing dialysis or a transplant) and meet the work and other rules for it.

You do not have to be retired to get Part A with no premium. You can keep working and still have it.

Can a spouse's work record count?

Yes. If you did not work enough, your husband's or wife's record may still qualify you. This helps many people who stayed home to raise children or care for family.

Social Security looks at three kinds of spouses. A current spouse, a former spouse from a long enough marriage, and a late spouse can all count. Social Security checks your marriage history and your spouse's credits for you.

You do not need your spouse's permission, and using the record does not lower your spouse's benefits. When you apply, tell Social Security about every marriage so it can check each record.

Who pays a Part A premium?

The table shows the deciding line: 40 credits. Above it, most people pay no premium. Below it, you can still get the same Part A coverage, but you pay for it each month.

The premium is lower for people who are close to 40 credits. It is higher for people with few or no credits. Medicare sets both amounts each year and publishes them at Medicare.gov.

If your income and savings are limited, your state may help. Medicare Savings Programs (state programs that help pay Medicare costs) can pay the Part A premium for people who qualify.

Should you keep working to reach 40 credits?

If you are a few credits short, working a little longer can change your costs. Each year of work can add up to 4 credits. Once you reach 40, your Part A premium stops.

You can start Part A as a premium-paying member and switch later. When your record reaches 40 credits, Social Security updates it, and the monthly Part A premium ends.

Working longer can also affect when you sign up for other parts of Medicare. If you have health coverage from a current job, see Working Past 65? When to Delay Medicare Enrollment.

When should you sign up for Part A?

Your first chance is the Initial Enrollment Period. It is 7 months long: the 3 months before your 65th birthday month, that month, and the 3 months after.

If you get Social Security benefits before 65, you are usually signed up for Parts A and B on your own. Your Medicare card arrives in the mail before your birthday month.

If you are not getting benefits yet, apply online at ssa.gov, by phone with Social Security, or at a local office. If you are using a spouse's record, have their full name, date of birth and Social Security number ready, plus the date you married.

If you must buy Part A and wait past your first chance, your premium goes up. That extra charge is a late enrollment penalty. You pay the higher premium for twice the number of full years you could have had Part A but did not sign up. People who get Part A with no premium do not owe this penalty. For all the sign-up windows, see Medicare Enrollment Periods: Key Dates, Windows and Rules.

Does no premium mean no costs?

No. Part A with no premium still has costs when you use it. In 2026, the inpatient hospital deductible is $1,736 for each benefit period. The amount is set each year.

A benefit period starts the day you are admitted to a hospital as an inpatient. It ends after you go a set time without inpatient hospital or skilled nursing care. You can have more than one benefit period in a year, and the deductible applies to each one.

Part B is separate. The 2026 standard Part B premium is $202.90 a month, and the 2026 Part B deductible is $283. Both amounts are set each year. Some people pay more for Part B because of higher income.

Some Medigap policies and Medicare Advantage plans help with the Part A deductible. What each plan pays differs, and plan details vary by location and carrier.

How can you check your work credits?

Social Security keeps your official count. Create a my Social Security account at ssa.gov to see your earnings record and your Social Security Statement. The statement shows whether you have enough credits for Medicare.

Look over each year of earnings. If a year is missing or looks too low, report it to Social Security. Fixing a mistake can add credits to your record.

Once you know your count, you know your Part A cost. With 40 or more credits on your own record or a spouse's, you pay no Part A premium. With fewer, you pay a premium set each year, and it stops once your record reaches 40.

Have questions? Call 1-877-443-3251 to talk it through with a licensed insurance agent. You never pay the agent; the plans they represent do, and the decision stays yours.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.