Medicare Part A is premium-free for most people — but "free" only means no monthly premium, and only if you or your spouse paid Medicare taxes for at least 10 years (40 quarters). In 2026, people with 30–39 quarters pay $311 a month for Part A; those with fewer than 30 quarters pay $565. And everyone, premium-free or not, faces the $1,736 deductible per hospital benefit period.
Here is what Part A actually costs in 2026, who owes a premium, and how the benefit-period math works.
Who gets Part A premium-free?
You qualify for premium-free Part A at 65 if any of these hold:
- You have 40+ quarters of Medicare-covered work (about 10 years).
- Your current, former, or deceased spouse has the 40 quarters — you can qualify on a spouse’s record, including some divorced and widowed spouses.
- You receive (or qualify for) Social Security or Railroad Retirement benefits.
Under 65, premium-free Part A also comes after 24 months of SSDI entitlement, or immediately with ESRD or ALS.
What do you pay if you don’t have enough quarters?
| Work history | 2026 Part A monthly premium |
|---|---|
| 40+ quarters (you or spouse) | $0 |
| 30–39 quarters | $311 |
| Under 30 quarters | $565 |
Two notes for premium payers: buying Part A generally requires also enrolling in Part B, and late enrollment can add a penalty of 10% on the Part A premium for twice the years you delayed. People still working past 65 with employer coverage usually avoid the penalty through a special enrollment period.
If those premiums are unaffordable, your state may pay them: the Qualified Medicare Beneficiary program covers Part A and B premiums for low-income enrollees — income limits are in our guide to Medicare Savings Programs in 2026.
What does Part A cost even when it’s premium-free?
The 2026 cost-sharing, per benefit period:
- $1,736 deductible for inpatient hospital admission (days 1–60)
- $434 per day for hospital days 61–90
- $868 per day for lifetime reserve days (60 total, ever)
- Skilled nursing facility: $0 for days 1–20, then $217 per day for days 21–100
A "benefit period" starts on admission and ends after 60 straight days out of the hospital/SNF — so you can pay the $1,736 deductible more than once in a year if admissions are spread out. This is the gap Medigap plans and Medicare Advantage out-of-pocket maximums exist to blunt.
Remember Part A is hospital insurance only. Doctor visits and outpatient care run through Part B, which has its own premium — see the 2026 Part B premium of $202.90 and who pays more — and drug coverage is Part D, now capped at $2,100 out of pocket.
Should you take Part A if you’re still working at 65?
Most people with premium-free Part A enroll at 65 even with employer insurance, since it costs nothing and can coordinate as secondary coverage. The one big exception: HSA contributions. Part A enrollment (which can be retroactive up to 6 months) makes you ineligible to contribute to a health savings account. If you’re funding an HSA, plan the timing before enrolling.
FAQ
Q. I never worked, but my spouse did. Do I pay for Part A?
A. If your spouse has 40 quarters and you’re 65 (married at least a year, or qualifying divorced/widowed rules), you get premium-free Part A on their record.
Q. Can I buy quarters or make up a shortfall?
A. You can’t buy quarters, but you can keep working — each year of covered work adds up to 4 quarters. Someone at 36 quarters is one working year away from dropping the premium from $311 to $0.
Q. Is there financial help with the $1,736 deductible?
A. Medigap plans cover it, Medicare Advantage restructures it, Medicaid pays it for dual eligibles, and QMB shields cost-sharing for those who qualify.
Q. Does everyone pay the same Part A premium regardless of income?
A. Yes — unlike Part B, Part A premiums depend only on quarters of coverage, not income.
Source: CMS — 2026 Medicare Parts A & B Premiums and Deductibles