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Who does NOT have to pay a premium for Medicare Part A?

Q: Who does NOT have to pay a premium for Medicare Part A?

2019 Medicare premiums, deductibles and out-of-pocket costsA: Most Medicare-eligible people do not have to pay premiums for Medicare Part A. If you are 65 and you or your spouse has paid Medicare taxes for at least 10 years, you don’t pay a premium for Part A. You may also not have to pay the premium:

  • If you haven’t reached age 65, but you’re disabled and you’ve been receiving Social Security benefits or Railroad Retirement Board disability benefits for two years.
  • You have end-stage renal disease (ESRD) and are receiving dialysis, and either you or your spouse or parent (if you’re a dependent child) worked and paid Medicare taxes for at least 10 years. Coverage typically begins the first day of your fourth month of dialysis, but it can begin in your first month of dialysis if you use in-home dialysis treatment.
  • You have amyotrophic lateral sclerosis (ALS) and are eligible for Social Security Disability Insurance (SSDI). Medicare coverage begins as soon as your SSDI begins, and Medicare Part A has no premiums as long as you or your spouse (or parent, if you’re a dependent child) worked and paid Medicare taxes for at least 10 years.

If you do have to pay Part A premiums, in 2019 you’ll pay either $240/month (if you or your spouse paid Medicare payroll taxes for at least 7.5 years, but fewer than 10 years) or $437/month (if you or your spouse paid Medicare payroll taxes for fewer than 7.5 years). These premiums are adjusted annually; for 2020, they’re projected to increase to $253/month and $460/month, respectively.

Everyone pays for Part B of Original Medicare; in 2019, the standard premium is $135.50/month for those making less than $85,000 per year ($170,000 per year for married couples filing jointly). In 2020, the standard premium is projected to increase to $144.30/month, although the threshold for having to pay higher premiums based on income is also increasing, to $87,000 for a single individual and $174,000 for a married couple (beneficiaries with higher incomes pay more for Medicare Parts B and D).

People who don’t enroll in Medicare B when first eligible are charged a late enrollment penalty that amounts to a 10 percent increase in premium for each year they were eligible for Medicare B but not enrolled. So if you wait until three years after you’re eligible to enroll, you’ll pay 30 percent more than the standard premium for Medicare B, for as long as you have the coverage. But this penalty does not apply if you delayed your Part B enrollment because you had employer-sponsored coverage from a current employer (or your spouse’s current employer) and used that coverage instead of Part B.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Related terms

Medicare Part A

Medicare Part B

Original Medicare

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