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About 99% of Medicare beneficiaries pay nothing for Part A. If you or your spouse paid Medicare taxes for at least 40 quarters, roughly ten years of work, your Part A premium is $0. The remaining group has to buy in, and the price is steep enough that it deserves its own guide. For 2026, CMS set the buy-in premium at $311 a month if you have 30 to 39 quarters of covered work, and $565 a month if you have fewer than 30 quarters.
Those figures come from the CMS premium announcement released November 14, 2025. The $565 full premium is up $47 from 2025, and the reduced premium is up $26. Over a year, the full premium alone costs $6,780 before you receive a single day of hospital care.
Who ends up paying for Part A
The buy-in group is smaller than most people expect, and it tends to be specific. Recent immigrants who arrived later in life may not have ten years of U.S. work history. So may people who spent their careers in jobs that did not pay into Medicare, some state and local government workers hired decades ago, and people who worked informally or spent many years caregiving without paid employment. A spouse’s work record counts, so a person who never held a paying job can still qualify for premium-free Part A on a spouse’s record if the marriage requirements are met.
You must also meet the other eligibility rules. Buy-in requires you to be 65 or older, a U.S. citizen or a lawfully present resident who has lived in the country for the required period, and enrolled in Part B. You cannot buy Part A on its own.
The premium is only the first cost
Premium-free Part A does not mean free hospital care, and paid Part A does not mean covered hospital care either. Everyone on Part A shares these 2026 costs when they use a hospital:
- Inpatient deductible: $1,736 per benefit period
- Days 1 to 60: $0 coinsurance after the deductible
- Days 61 to 90: $434 a day
- Lifetime reserve days: $868 a day, and you get 60 of these days in your lifetime
- Skilled nursing facility, days 21 to 100: $217 a day, after a qualifying hospital stay
The deductible is charged per benefit period, not per year. A benefit period starts when you are admitted and ends after you have been out of the hospital and any skilled nursing facility for 60 days in a row. Two separate hospital stays in one year can mean paying the $1,736 deductible twice. This is the cost that catches families who assumed the deductible worked like the annual deductible on a regular health plan. Our explainer on Medicare Parts A, B, C, and D covers how the parts divide these costs.
The late enrollment penalty for Part A
If you have to buy Part A and you sign up late, Medicare adds a penalty of 10% to your premium. The penalty lasts for twice the number of years you delayed. Delay two years and you pay the extra 10% for four years. On the $565 full premium, that is an extra $56.50 a month. The penalty does not apply to premium-free Part A, because there is no premium to add it to.
People who are still working at 65 with qualifying employer coverage generally get a special enrollment period that protects them from this penalty when the job or the coverage ends. The details matter, and retiree coverage and COBRA do not protect you the way active employer coverage does. Our guide to working past 65 with Medicare and employer coverage explains which coverage counts.
Ways to reduce the buy-in cost
If $311 or $565 a month is out of reach, check the Medicare Savings Programs before you give up on Part A. The Qualified Medicare Beneficiary program can pay your Part A premium if you owe one, along with your Part B premium and most cost sharing, if your income is low enough. The 2026 federal income limit for that program is $1,350 a month for an individual, and some states set more generous rules. Our guide to Medicare Savings Programs in 2026 lists the limits for each program.
There is also a work-based route. Quarters of coverage are credited in the year you earn them, and the earnings needed for a quarter are modest compared with the premium. Someone a few quarters short of 40 who can do part-time covered work for a year or two may come out well ahead by reaching premium-free status instead of paying $565 a month for decades. Run the math on your own record through your Social Security account before you decide, because your statement shows exactly how many quarters you have.
Deciding whether to buy in
Skipping Part A because of the premium leaves you exposed to hospital bills with no cap at all. A single stay that runs past 60 days costs the $1,736 deductible plus $434 a day, and that is with Part A paying its share. Without Part A you owe the hospital’s full charges. For most people who have to buy in, the premium hurts and the alternative hurts more. Compare your options against the full picture in our breakdown of what Medicare costs in 2026, and check whether your state will help with the premium before you pay it alone.
