Your work and tax history don’t determine your Medicare eligibility. However, this does affect whether you qualify for premium-free Part A.
You can generally enroll in Medicare at age 65 or earlier if you live with specific conditions or through an eligible spouse.
Once you’re eligible, however, Medicare Part A (hospital insurance) is generally only premium-free if you’ve worked and paid taxes for a decade. That said, the exact requirements for this depend on how you’re eligible for Medicare.
After securing Part A, you can also buy Part B (medical insurance) and Part D (drug insurance). Once you have Parts A and B, you can switch to Medicare Advantage (Part C) for equivalent benefits from a private plan. These Medicare parts aren’t available premium-free.
Read on to learn more about the relationship between your work history and Medicare.
Medicare is health insurance provided through the U.S. government. It’s available once you turn 65 or earlier under certain conditions.
Through the Federal Insurance Contributions Act (FICA), the government funds Medicare Part A through a trust that includes both tax contributions and premium payments.
For this reason, if you’re eligible for Medicare based on turning 65, you generally don’t pay a premium for Medicare Part A as long as you’ve worked for 40 quarters (10 years or 40 work credits) in the United States and your earnings were taxed.
That said, you might also qualify for free Medicare Part A if you’re 65 and your current or former spouse has worked the required time as follows:
- You’re married to a spouse who qualified for Social Security benefits for at least one year before applying.
- You’re divorced and currently single, but you were married for at least 10 years to a spouse who qualifies for Social Security benefits.
- You’re widowed and currently single, but you were married for at least 9 months before your spouse died, and they qualified for Social Security benefits.
Another way to qualify for premium-free Part A without having the standard required work history is if you’re eligible based on receiving disability benefits or living with either amyotrophic lateral sclerosis (ALS) or end stage renal disease (ESRD). In this case, your employment requirement is as follows:
| Age | Working quarters |
|---|---|
| 24 years or younger | 6 work credits acquired during the 3 years preceding the onset of a disability |
| 24-31 years | employed for at least half the time between turning 21 and the onset of a disability |
| over 31 years | accumulated at least 20 work credits over a span of 10 years prior to developing a disability |
What happens if you don’t have enough credits for Medicare?
If you’re eligible for Medicare, you can still get Medicare Part A coverage for the cost of a monthly premium.
Here’s what you’ll pay in 2025:
- If you have 30 to 39 credits, your Part A premium will cost $285 per month.
- If you have fewer than 30 credits, your Part A premium will cost $518 per month.
- If you can continue working and accumulate 40 work credits, you won’t have to pay the monthly premium for Part A coverage.
Once you have premium-free Part A, you can choose to purchase Medicare Part B (medical insurance) and Part D (drug coverage). These Medicare parts aren’t available premium-free because they’re funded by congressional funds and premium payments, but not from taxes.
For this reason, once you enroll in Medicare Part B, you will pay a monthly premium of $185 in 2025. Your premium may be higher if your income is higher.
Note, however, that if you’re paying for Part A, enrolling in Part B becomes mandatory.
Parts C and D
Medicare Part D plans are offered by private insurers, which charge varying premiums depending on the plan. The national base beneficiary premium will be $36.78 in 2025.
In addition, as long as you’re enrolled in Original Medicare (Parts A and B), you also have the option to switch to Medicare Advantage (Part C), which offers the same benefits via a private insurer and often additional benefits like vision and dental care.
These plans also have varying costs based on the insurance provider and the state regulations where you live. According to the Centers for Medicaid & Medicare (CMS), the average monthly premium for Part C plans is around $17.00 in 2025.
As long as you qualify for Medicare, you enroll in Medicare the same way, regardless of how long you’ve worked.
What makes you not eligible for Medicare?
You might not qualify for Medicare unless you’re a U.S. citizen or have legally resided in the U.S. for a minimum of 5 years. In this case, you cannot enroll in Medicare even if you meet the standard eligibility criteria.
If you or your qualifying spouse are receiving benefits from the SSA or RRB, you’ll be automatically enrolled in Medicare Parts A and B. You can then sign up for Part D or switch to Medicare Advantage (Part C) during your initial enrollment period.
If you’re not automatically enrolled, you’ll need to apply for Original Medicare (Parts A and B) and any desired coverage. The Social Security Administration (SSA) provides a checklist for Medicare applications, detailing necessary documents like proof of military service, tax forms, and W-2s.
When you’re ready to enroll, you can do so online at SocialSecurity.gov, by phone at 800-772-1213 (or 1-800-325-0778 for TTY), in person at your local SSA office, or by mail.
Most people who are eligible for Medicare coverage won’t have to pay a monthly premium for Part A because they paid Social Security taxes for 40 quarters (approximately 10 years) throughout their working years. You can also qualify based on a disability, with slightly different employment requirements.
That said, if you haven’t worked for the required time, you can still get Medicare Part A by paying a monthly premium. All other Medicare parts require a monthly premium as well.
Important Medicare 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.
