Key Takeaways

• While Medicare Part A is premium-free for most, you could still have to pay for it if you don’t meet specific work history requirements.

• Knowing the cost, enrollment periods, and penalties for late enrollment can help you avoid unnecessary expenses.

Understanding Why Part A Isn’t Always Free

Medicare Part A, often called “hospital insurance,” is widely believed to be free. This is true for many, but not for everyone. If you haven’t worked long enough in a job that paid Medicare taxes, or if your spouse doesn’t qualify, you may be required to pay a monthly premium to get Part A coverage.

In 2025, eligibility for premium-free Part A hinges on your work history or that of your spouse. If neither of you has earned at least 40 quarters (equivalent to 10 years) of Medicare-covered employment, you will have to pay a monthly premium. Let’s explore when and why that might happen, what it costs, and what your options are.

What Does Part A Actually Cover?

Before diving into premiums, it’s important to understand what you’re paying for.

Medicare Part A helps cover:

• Inpatient hospital care

• Skilled nursing facility (SNF) care (following a qualifying hospital stay)

• Hospice care

• Limited home health services

Part A doesn’t cover long-term custodial care, private-duty nursing, or most non-medical services at home. Even when covered, you may still face deductibles, coinsurance, and other out-of-pocket expenses.

Who Gets Part A Without a Premium?

You qualify for premium-free Part A if:

• You (or your spouse) worked and paid Medicare taxes for at least 40 quarters (10 years).

• You’re receiving or eligible for Social Security or Railroad Retirement Board benefits.

• You’re under 65 and disabled, and you’ve received Social Security Disability Insurance (SSDI) for 24 months.

• You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease).

If none of these apply, you will likely need to pay for Part A.

Who Has to Pay for Part A in 2025?

You will have to pay a premium for Part A in 2025 if:

• You have fewer than 30 quarters of Medicare-covered employment.

• You have 30-39 quarters of coverage but still fall short of the 40-quarter requirement for premium-free eligibility.

Current Premiums

• If you have fewer than 30 quarters, the premium is $518 per month.

• If you have 30-39 quarters, the premium is $284 per month.

These amounts are set by Medicare and apply to all eligible individuals who fall into these categories.

Can You Buy Part A Even If You Don’t Qualify?

Yes. You can purchase Part A coverage during certain enrollment periods if you’re not eligible for premium-free Part A. But there are conditions:

• You must also enroll in Medicare Part B.

• You must be age 65 or older, or meet disability criteria.

• You must be a U.S. citizen or lawfully present resident.

Failure to sign up during the appropriate enrollment window may result in penalties, and that’s where things can get costly.

Enrollment Periods Matter

Timing plays a crucial role in avoiding penalties and gaps in coverage. If you need to buy Part A, here are the key enrollment periods:

Initial Enrollment Period (IEP)

• Begins 3 months before the month you turn 65, includes your birth month, and continues for 3 months after.

• If you’re under 65 and qualify due to disability, your IEP begins 3 months before your 25th month of disability benefits.

General Enrollment Period (GEP)

• Runs from January 1 to March 31 each year.

• Coverage begins July 1 of that year.

• Late enrollment penalties may apply.

Special Enrollment Period (SEP)

• For those who delayed Part A and B due to employer-sponsored coverage.

• You have 8 months after losing job-based coverage to enroll.

If you miss these periods, you may be subject to late penalties.

Late Enrollment Penalty for Part A

The penalty for late enrollment in premium-based Part A is:

• 10% surcharge on your monthly premium.

• This penalty applies for twice the number of years you could have had Part A but didn’t enroll.

For example, if you were eligible to purchase Part A for 2 years but didn’t, you would pay the higher premium for 4 years. That’s in addition to the standard premium.

Can You Reduce or Eliminate the Premium?

If you currently don’t qualify for premium-free Part A, you might be able to in the future. Here are a few ways that can happen:

• Work More Quarters: If you or your spouse gain more Medicare-covered work experience, your premium may be reduced or eliminated.

• Spousal Eligibility: If your spouse turns 62 and has 40 quarters of coverage, you may qualify based on their record.

Until then, you’ll have to pay premiums to maintain Part A coverage.

Do You Really Need to Buy Part A?

This depends on your situation. You should consider purchasing Part A if:

• You expect to use inpatient hospital services.

• You need coverage for skilled nursing or hospice care.

• You plan to enroll in other parts of Medicare, such as Part B and D, and want full hospital coverage.

Not enrolling in Part A may limit your access to some health services and could affect your ability to enroll in other Medicare coverage options.

What Happens If You Skip Part A Entirely?

If you don’t enroll in Part A:

• You may face a penalty later.

• You might not be able to enroll in certain Medicare Advantage plans or Medigap policies.

• Your hospital-related costs could be significantly higher.

The financial risks of being uninsured in retirement are substantial. Medical emergencies or hospitalizations without Part A coverage can result in large out-of-pocket expenses.

Coordinating Part A With Other Coverage

You might already have some form of health insurance, such as:

• Employer-sponsored coverage (if still working at 65+)

• Retiree insurance

• TRICARE (for military retirees)

In such cases, you should compare the benefits and cost of keeping that coverage versus enrolling in Part A. Medicare can act as primary or secondary insurance, depending on your circumstances.

If you buy Part A, it can help fill coverage gaps and protect you from unexpected hospital costs, especially if your current insurance is limited in scope.

When You Turn 65: Checklist for Part A Decision

As you approach your 65th birthday, use this simple checklist to determine whether you need to enroll in Part A:

If you answer “no” to the first three questions and don’t have comparable coverage, enrolling in Part A is likely in your best interest.

How to Enroll in Part A If You Have to Pay

If you determine that you must buy Part A, follow these steps:

1. Visit the Social Security website or your local office.

2. Enroll during one of the valid periods (IEP, GEP, SEP).

3. Also enroll in Part B (required if buying Part A).

4. Pay the monthly premium based on your work history.

Be proactive. Missing deadlines leads to penalties and delayed coverage. Keeping a calendar and setting reminders can help you stay on track.

It’s Not Just About the Premium—Other Costs Add Up

In addition to the monthly premium, you must also consider:

• Inpatient hospital deductible: $1,676 per benefit period in 2025.

• Coinsurance: After day 60 of a hospital stay, you pay daily coinsurance starting at $419.

• Skilled nursing coinsurance: $209.50 per day for days 21-100.

Even with Part A, you may want supplemental coverage to reduce these expenses. But again, those options may require that you already have Part A.

Why Paying for Part A Might Still Be Worth It

Despite the cost, purchasing Part A may be a wise investment. Without it, your exposure to hospital bills could be devastating. Having Part A coverage in place ensures you have access to:

• Affordable inpatient hospital care

• Hospice services

• Skilled nursing facilities when needed

• Eligibility for other parts of Medicare

Even if you must pay out-of-pocket for the premium, the coverage offers significant protection.

Take the Next Step With Confidence

Understanding when and why you might need to pay for Medicare Part A is critical to making informed decisions about your healthcare in retirement. If you find yourself ineligible for premium-free coverage, don’t delay evaluating your options.

Review your work history, talk to your spouse about their employment, and assess whether your current coverage is enough. If it’s not, purchasing Part A could be the safer choice.

If you’re uncertain about whether you need to pay, when to enroll, or how it fits with your existing plan, speak with a licensed agent listed on this website. Getting the right advice now could save you from expensive surprises later.