- If you’ve never worked, you may still qualify for premium-free Medicare Part A. This is based on your spouse’s work history or if you have certain medical conditions or disabilities.
- It’s also possible to get Medicare coverage if you pay a monthly Part A premium.
Most Medicare beneficiaries don’t pay a premium for Medicare Part A (hospital coverage). This is because, while you worked, your earnings were taxed for a certain length of time and paid into the Federal Insurance Contributions Act, which funds Medicare.
In general, Medicare is available premium-free if you’ve worked a total of 40 quarters (10 years or 40 work credits). But can you still get Medicare if you haven’t worked for that length of time during your life?
The short answer is yes. You can get free Medicare Part A through your spouse or if you have certain medical conditions or disabilities. You can also choose to pay for Part A if you don’t qualify.
In this article, we’ll discuss how you can get Part A with or without a monthly premium, how your work history affects eligibility for other parts of Medicare, and more.
Medicare is health insurance that’s provided through the U.S. government. It’s available once you turn 65 years old or if you:
- receive Social Security disability benefits for at least 2 years
- receive disability pension benefits from the Railroad Retirement Board
- have amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease
- have end stage renal disease (ESRD) or kidney failure
Most people don’t have to pay monthly premiums for Medicare Part A (hospital coverage) because they’ve paid a portion of their earnings into the system for at least 40 quarters throughout their working years.
You can also qualify for premium-free Medicare Part A through your spouse or parent. You may also enroll in and pay for Part A coverage yourself.
If you haven’t worked for the required length of time, there are two main ways you can still qualify for Medicare Part A without a monthly premium.
Through your spouse
When you turn 65 years old, you may be eligible for Medicare Part A if your spouse has worked for at least 40 quarters.
If you’re currently married:
- your spouse must be eligible for Social Security disability or retirement benefits
- you must have been married for at least 1 year
If you’re divorced:
- your former spouse must be eligible for Social Security disability or retirement benefits
- you must have been married at least 10 years
If you’re a widow or widower:
- your spouse must have been eligible for Social Security disability or retirement benefits
- you must have been married for at least 9 months before your spouse passed away
- you must be currently single
Medical conditions and disabilities
If you have certain disabilities, you may be eligible for premium-free Medicare Part A benefits even if you’re under 65 years old.
Social Security Disability Insurance (SSDI) recipients
If you have a disability and have been receiving SSDI benefits for at least 24 months (2 years), you will automatically be enrolled in premium-free Medicare at the beginning of the 25th month.
- you qualify for Social Security retirement benefits
- you qualify for Railroad Retirement Board benefits
- your spouse or parent (living or deceased) worked long enough to be eligible for Social Security retirement benefits
When you become eligible for Medicare benefits depends on whether you receive dialysis at home or in a treatment facility.
If you’re receiving dialysis in your home, you can apply for Medicare the first day you begin your dialysis program. You need to be sure to apply before the third month of treatment.
If you receive dialysis in a treatment facility, you can apply for Medicare on the first day of the fourth month of your treatment.
If you’re scheduled to receive a kidney transplant, you can apply for Medicare on the first day of the month you’re admitted to the hospital to start preparing for the transplant. But if your transplant is delayed, your Medicare benefits won’t start until 2 months before the month your transplant takes place.
If you have ALS, you’re automatically eligible for premium-free Medicare Part A, which will begin as soon as your SSDI benefits begin.
When you sign up for SSDI, you’ll have a 5-month waiting period before your benefits start. After your waiting period is up, your Medicare and SSDI benefits begin the same month.
If you don’t have enough work history or meet the criteria discussed above to get premium-free Medicare Part A, you can still get coverage by paying the monthly premiums on your own.
To apply, you must be 65 years old and a U.S. citizen or a lawfully admitted noncitizen who has lived in the United States for 5 years or more.
If you buy Medicare Part A coverage, you must also enroll in Medicare Part B and pay those monthly premiums.
The 2021 monthly premium for Part A coverage can be up to $471 per month. The monthly premium for Medicare Part B coverage is typically $148.50, but you may have to pay a higher Part B premium if you have a higher income level.
What if I’ve worked, but not long enough?
You can still get Medicare Part A coverage, even if you don’t fully meet the work requirement of 40 credits. Here’s what you’ll pay in 2021:
- If you have 30 to 39 credits, your Part A premium will cost $259 per month.
- If you have fewer than 30 credits, your Part A premium will cost $471 per month.
- If you’re able to continue working and you accumulate 40 work credits, you won’t have to pay the monthly premium for Part A coverage.
Part A is the only part of Medicare that requires a specific amount of work history. You can enroll in Medicare parts B, C, and D without a work history.
Medicare Part B
Medicare Part B covers outpatient medical services, such as doctors’ visits. There’s no work history requirement to enroll in Medicare Part B. You can enroll as long as you’re at least 65 years old.
You must enroll in Medicare Part B during specific enrollment periods.
Your first opportunity to enroll begins 3 months before the month you turn 65 and ends 3 months after that month. This 7-month window is called your initial enrollment period. If you don’t enroll in Medicare Part B during this time, you may have to pay a penalty if you enroll later.
If you miss your initial enrollment period, you can also enroll in Part B during the general enrollment period from January 1 through March 31. Finally, if you have certain significant life events, this may trigger a special enrollment period, which lasts for 8 months after the event.
Once you enroll in Medicare Part B, you will pay a monthly premium of $148.50 in 2021. Your premium may be more if your income is higher.
Medicare Part C (Medicare Advantage)
Medicare Advantage is a private insurance option that offers the same basic benefits as original Medicare (Part A and Part B), plus additional benefits like vision and dental care. You must be eligible for original Medicare to qualify for a Medicare Advantage plan.
Although all Medicare Advantage plans must provide the same basic coverage as original Medicare, their costs and added benefits vary based on the insurance provider and the state regulations where you live. You can use the Medicare plan finder tool to compare plans.
You can enroll in a Medicare Advantage plan or switch Medicare Advantage plans only at certain times.
One is during your initial enrollment period, around your 65th birthday. You can also sign up during Medicare’s open enrollment period (October 15 through December 7) or the Medicare Advantage open enrollment period (January 1 through March 31).
And if you have certain major life events, you may be eligible for a special enrollment period.
Medicare Part D
Medicare Part D offers prescription drug benefits.
While this plan is optional, Medicare requires you to have sufficient prescription drug coverage within 63 days of the date you become eligible for Medicare. This applies whether you get that coverage through Medicare, your employer, or another source.
If you don’t enroll in a Part D plan when you’re first eligible and you later decide to enroll, you could face a permanent late enrollment fee.
You can add, change, or drop a Part D plan during your initial enrollment period or during the annual open enrollment period (October 15 through December 7). If you have a Medicare Advantage plan, you can change your drug coverage from January 1 through March 31 each year.
The national base beneficiary premium for Part D plans is $33.06 per month in 2021.
Medigap policies are optional supplemental policies offered by private insurance companies. They help you pay your Medicare copays, coinsurance, and deductibles.
To enroll in one of the 10 available Medigap policies, you must already be enrolled in original Medicare.
The costs of Medigap policies vary because each plan covers different medical fees. Some Medigap policies cap the amount of out-of-pocket expenses you will have to spend each year, while others have no cap.
You can enroll in a Medigap policy only at certain times of the year. One time is during your initial enrollment period. The other is during the Medigap open enrollment period.
If you’re 65 years old, the Medigap open enrollment period starts when you enroll in Part B. If you haven’t yet turned 65 years old, this enrollment period lasts until 6 months after you’ve turned 65 years old and also enrolled in Part B.
Insurance companies don’t have to sell you a Medigap policy, so your best bet is to enroll in a Medigap plan during your initial enrollment period if you think you may need this type of extra coverage.
If you need help paying your Medicare costs, there are federal and state programs that can assist you, including:
- Medicare savings programs
- PACE (Programs of All-Inclusive Care for the Elderly)
- Extra Help, for help paying Part D costs
Medicare eligibility can be complicated, so if you still have questions, you can contact Medicare directly by calling 800-MEDICARE. You can also get impartial guidance through your local State Health Insurance Assistance Program (SHIP).
Most people who are eligible for Medicare Part A coverage won’t have to pay a monthly premium because they paid Social Security taxes throughout their working years.
If you haven’t worked 40 quarters (approximately 10 years), you can still get Medicare Part A coverage premium-free if you have certain disabilities or based on your spouse or parent’s work history.
Even if you’re not eligible for premium-free Medicare Part A, you may still be able to get coverage if you pay the monthly premiums yourself.
Important deadlines and penalties may apply if you don’t enroll when you are first eligible, so it’s a good idea to reach out for assistance if you’re not sure which enrollment deadlines apply to you.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.