Don’t have  10 Years of Work?

Your Medicare Part A Options in California

• Most people do not pay a monthly premium for Medicare Part A because they or their spouse worked and paid Medicare taxes for approximately 10 or more years.  This is called premium-free Part A.
• If you do not have enough Medicare work credits, that does not necessarily mean you are out of options. Depending on your work history, marital history, immigration status and income, you may be able to:
  • Qualify for premium-free Part A through your own or a spouse’s work record.
  • Buy Medicare Part A and enroll in Part B.
  • Have Medi-Cal pay some or all of your Medicare premiums.
  • Choose Covered California instead of purchasing Medicare Part A.
• Important:
  • Premium-free Part A means that there is no monthly Part A premium.
  • It does not mean that all hospital care is free.
  • Medicare deductibles, coinsurance and other expenses may still apply.
• Resources
  •  ssa.gov/ /EN-05-10072  How You Earn Credits  
  • Scroll down for more information

 Which Situation Describes You?

• You or your spouse worked and paid Medicare taxes for  10 or years:
  • Get an online Social Security Account and verify the numbers and information.  No reason you shouldn’t qualify for Social Security and Medicare.
• You are a U.S. citizen but do not have enough work credits:
  • You may be able to purchase Medicare Part A and enroll in Part B.
• You are a lawful permanent resident who has not completed five years of continuous U.S. residence:
  • You may have to wait before you can buy Medicare based on age.
  • Covered California or Medi-Cal may be available during the waiting period.
• You have limited income and qualify for Medi-Cal:
  • Medi Cal  may be able to pay your Medicare premiums through a Medicare Savings Program.
• You must pay a premium for Part A:
  • Before enrolling, compare the total cost of Medicare with a  Covered California plan for someone age 65 or older
    .

See California Health Plans and Possible Subsidy

New to the United States?

Medicare May Have a Five-Year Waiting Period

• The five-year Medicare residency rule generally applies to a person who:
  • Is age 65 or older.
  • Is not a U.S. citizen.
  • Is lawfully admitted for permanent residence.
  • Is applying for Medicare based on age rather than through another Medicare entitlement.
• A lawful permanent resident generally must have lived continuously in the United States during the five years immediately before the month of applying for Medicare based on age.
• A U.S. citizen is not subject to this particular five-year lawful-permanent-resident waiting requirement.
• What can you do during the five-year wait?
  • Apply for a Covered California health plan if you are lawfully present and otherwise eligible.
  • See whether you qualify for financial assistance based on household income, household size, tax filing status and other eligibility rules.
  • Apply for Medi-Cal if your income and circumstances may qualify.
  • Keep records showing when you began continuously residing in the United States.
• Social Security makes the final decision about when the five-year period began. Do not automatically assume that Social Security will use only the date printed on the green card. Ask Social Security to review the person’s complete immigration and residency history.
• Resources
  • Review Medicare enrollment information from Social Security
    
  •  justice in aging.org/older-immigrants-and-medicare/
  • Lawfully Present – Immigration Status
  • Age 65 – Can you get Tax Credits Subsidies Covered CA?
  • APTC Advance Premium Tax Credit – Subsidies ARPA
  • Medi-Cal – MAGI Income Eligibility Criteria
    • Aged and Disabled Federal Poverty Level Program

First, Find Out Whether Part A Can Be Premium-Free

Before deciding to buy Part A, ask Social Security to check every possible work record that may apply.

• Your own Medicare-covered employment.
• Your current spouse’s work record.
• A former spouse’s work record, when Social Security’s marriage and divorce requirements are met.
• A deceased spouse’s work record, when survivor eligibility rules are met.

Most people qualify after earning approximately 40 Medicare work credits, commonly described as 10 years of Medicare-covered work.

A spouse who did not work may qualify through the working spouse. However, if the working spouse is younger than 62, premium-free Part A for the older spouse may not become available until the working spouse reaches age 62.

Estimate Medicare Eligibility and the Part A Premium

What Does It Cost to Buy Medicare Part A in 2026?

The amount depends on how many quarters of Medicare-covered work you or your spouse have.

• You must also enroll in Part B to purchase Part A. The standard Part B premium is $202.90 per month in 2026. A higher-income adjustment may apply to some people.
  • $311 Part A plus standard Part B: $513.90 per month.
  • $565 Part A plus standard Part B: $767.90 per month.
  • Medicare.Gov See Current Medicare Costs  Webpage
• These totals are before any
  • prescription drug plan,
  • Medicare Advantage plan premium,
  • Medigap premium,
  • deductible, copayment or coinsurance.
• See Our Medicare Enrollment Instructions
• Medicare.Gov See Current Medicare Costs  Webpage
• The Medicare Part A Buy-in  Medicare Rights
  • ncoa.org/ medicare-buy-in-programs/
  •  dhcs.ca.gov medicare-premium-payment-buy-in-program/
  •  cms.gov/ buy in  faqs.pdf

Can Medi-Cal Pay Your Medicare Premiums?

Possibly. Before paying hundreds of dollars each month for Part A and Part B, apply for a

Medicare Savings Program
.

California became a Medicare Part A Buy-In state in 2025. Under this program, California may enroll an eligible Medi-Cal member in Medicare Part A and pay the Part A premium.

This is especially important for someone who:

• Does not have enough work credits for premium-free Part A.
• Is enrolled in Medicare Part B.
• Qualifies for the Qualified Medicare Beneficiary program, commonly called QMB.
• Has full-scope Medi-Cal and meets the program’s other eligibility requirements.

Depending on the Medicare Savings Program, assistance may include Part A or Part B premiums and certain Medicare deductibles, coinsurance and copayments.

Can Medi-Cal Pay My Medicare Premiums?

Can I Use Covered California Instead of Buying Medicare Part A?

• Possibly. If you are not eligible for premium-free Part A and would have to pay for it, you may be able to choose a Covered California plan instead of enrolling in premium Part A.
• Depending on your household income and other eligibility rules, you may qualify for a subsidy that lowers your Covered California premium.
• Read our detailed explanation of
  • Covered California subsidies after age 65 when you do not qualify for premium-free Part A
    .

See Your California Plans and Possible Subsidy

What Should You Do Next?

1. Check your Medicare work credits.
   1. Ask Social Security whether you qualify through your own, a spouse’s, former spouse’s or deceased spouse’s work record.
   2. Do this ONLINE!  
2. Confirm the five-year residency date.
   1. If you are not a U.S. citizen, ask Social Security when you first meet Medicare’s residency requirement.
   2. Do this ONLINE! 
3. Find out what Medicare would cost.
   1. Determine whether your Part A premium would be $0, $311 or $565 per month, in addition to Part B.
   2. Scroll down for more details
4. Apply for Medicare premium assistance.
   1. See whether Medi-Cal or a Medicare Savings Program could pay your premiums.
   2. Scroll up and down for links
5. Compare Covered California.
   1. If you must pay for Part A, compare the total Medicare cost with your Covered California premium after any available subsidy.
   2. Be careful of the details
      1. Age 65 – Can you get Tax Credits Subsidies Covered CA?
6. Review enrollment deadlines.
   1. Do not assume you can delay Medicare indefinitely without a penalty or restricted enrollment period.

Medicare Enrollment Instructions
See California Health Plans

Frequently Asked Questions

• Can I qualify for free Part A through my spouse?
  • Possibly. Social Security may use the Medicare-covered work record of a current spouse and, in some situations, a former or deceased spouse. Ask Social Security to check all potentially applicable records.

• My spouse has 10 years of work, but my spouse is younger than 62. Can I qualify?
  • You may have to wait until the working spouse reaches age 62 before premium-free Part A becomes available on that spouse’s record. However, you may still need to enroll in Part B when you first become eligible unless you have qualifying employer group coverage.

• Can I enroll in Part B without buying Part A?
  • Some people who meet Medicare’s age, citizenship and residency requirements can enroll in Part B without purchasing premium Part A. Ask Social Security to confirm your eligibility, enrollment period and possible penalties.

• Can I get a Medicare Advantage or Medigap plan without Part A?
  • Generally, you need both Part A and Part B to join a Medicare Advantage plan. You also generally need both Part A and Part B before purchasing a Medigap policy.

• Does the five-year wait mean I must remain uninsured?
  • No. A lawfully present California resident may be able to obtain Covered California or Medi-Cal coverage while waiting to meet Medicare’s residency requirement.

• Will Covered California prevent a future Medicare penalty?
  • Not necessarily. Covered California is not the same as employer group health coverage based on current employment. Before delaying Medicare, ask Social Security how a delay would affect your future enrollment period and premiums.

Not Sure Whether Medicare or Covered California Is Better?

I can help you compare the insurance choices and estimated premiums available in California. Social Security makes the final decision about Medicare work credits, residency requirements, eligibility dates and late-enrollment penalties.

Email Steve

Schedule a Meeting

Steve Shorr Insurance provides insurance information and assistance for California residents. This page is educational and is not legal, tax or Social Security advice.

Related Steve Shorr Pages and Official Medicare & California Resources

• Medicare Part A costs and eligibility
  • Medicare.gov — Current Medicare premiums, deductibles and other costs
    
    •  Estimate Medicare eligibility and the Part A premium
      
    • 10050-medicare-and-you.pdf
• 40 Quarters of work credits
  •  ssa.gov/ how you earn credits 10072.pdf
  • If You Are Self-Employed  10022
    •  colvin hallett law.com self-employed-dont-miss-future-social-security-benefits-filing-tax-returns-late/
• Enrolling in Medicare Parts A and B
  • Our Medicare Enrollment Instructions
    
  • Medicare.gov — When Medicare coverage starts
    
    •  Avoid Medicare late-enrollment penalties
      
• Medicare residency and the five-year requirement
  • Our Medicare, Covered California and Health Insurance Residency Page
    
  • Social Security — Official five-year continuous U.S. residency requirements
    
  • Our Lawful Presence and Immigration Rules Page
    
• Covered California after age 65
  • Our Page on Covered California Subsidies After Age 65
    
  • Covered California — Coverage choices for people eligible for Medicare
    
  • Medicare & the Health Insurance Marketplace  pdf  HTML 
• Medi-Cal help paying Medicare premiums
  • Our Medicare Savings Program Page — Can Medi-Cal Pay Your Medicare Premiums?
    
  • Our Aged and Disabled Medi-Cal Page
    
  • California DHCS — Medicare Savings Programs and Part A Buy-In
    
  • Medicare.gov — Medicare Savings Program benefits
    

Page reviewed and updated August 2026. Medicare premiums, eligibility requirements and program rules may change.