No 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 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.
Which Situation Describes You?
- You or your spouse worked and paid Medicare taxes for approximately 10 years:
Ask Social Security whether you qualify for premium-free Part A. - 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:
California 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
.
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.
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.
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.
| Medicare Work History | 2026 Part A Premium |
|---|---|
| Generally 40 or more quarters | Usually $0 per month |
| 30–39 quarters | $311 per month |
| Fewer than 30 quarters | $565 per month |
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.
- See Current Medicare Costs
These totals are before any prescription drug plan, Medicare Advantage plan premium, Medigap premium, deductible, copayment or coinsurance.
See Our Medicare Enrollment Instructions
Amounts shown are for 2026 and can change each year.
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 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
.
Important: Premium Part A and Covered California Subsidies
- You may be able to keep Covered California financial assistance if you decline premium Part A and otherwise qualify.
- You generally cannot enroll in premium Part A and continue receiving Covered California premium assistance.
- Covered California coverage does not automatically protect you from future Medicare enrollment restrictions or late-enrollment penalties.
- Compare both choices before enrolling in Medicare or cancelling Covered California.
What Should You Do Next?
- Check your Medicare work credits.
Ask Social Security whether you qualify through your own, a spouse’s, former spouse’s or deceased spouse’s work record. - Confirm the five-year residency date.
If you are not a U.S. citizen, ask Social Security when you first meet Medicare’s residency requirement. - Find out what Medicare would cost.
Determine whether your Part A premium would be $0, $311 or $565 per month, in addition to Part B. - Apply for Medicare premium assistance.
See whether Medi-Cal or a Medicare Savings Program could pay your premiums. - Compare Covered California.
If you must pay for Part A, compare the total Medicare cost with your Covered California premium after any available subsidy. - Review enrollment deadlines.
Do not assume you can delay Medicare indefinitely without a penalty or restricted enrollment period.
Medicare Enrollment Instructions
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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.
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
- Enrolling in Medicare Parts A and B
- Medicare residency and the five-year requirement
- Covered California after age 65
- Medi-Cal help paying Medicare premiums
Page reviewed and updated August 2026. Medicare premiums, eligibility requirements and program rules may change.
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Child & Sibling Pages
- ONLINE Account for Medicare & Social Security
- Part A Hospital – when it’s not Free – 40 quarters
- Part B Medicare Doctor Visits Out of Hospital Enrollment or Wait?
- General Enrollment Period GEP
- Medicare enrollment, if covered by Employer Plan? Retiring?
- Medicare Part B Late Enrollment Penalty
- Medicare Special Enrollment Period (SEP)
- MSP Medicare Savings Program Medi Cal pays Part B premium
- Preventative Care – Medicare
- VA compared to Medicare A, B, C, D & Medi Gap
- Why Is Medicare Billing Me for 3 or 4 Months at Once?
How do I buy Medicare Part A Hospital if I don’t have 10 years of working?
How can I get Medicare if I don’t qualify for FREE Part A Medicare?
- If you don’t have enough credits and have to buy Part A, you’ll pay the Part A premium aka Premium Part A which runs up to $505 each month Medicare.Gov *
- medicare.gov/medicare-costs
- How to earn Social Security – Medicare Credits Publication # 10072 *
- cms.gov/enrollment-renewal/original-part-a-b
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Watch out for penalties if you don’t enroll when you are supposed to.
- Tool to see when you can sign up for Medicare * Medicare.Gov
- dhcs.ca.gov/medicare-premium-payment-buy-in-program
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If you are lawfully present, over age 65, but not eligible for Premium Free Medicare – You qualify for Obamacare! Including Subsidies Get FREE Quotes. * Subsidies.
- When & how to enroll
- Are there Alternatives to paying $506 /month? Medicare.Gov
- If you qualify for Medi Cal, Medi Cal might pay your Medicare Premiums
- Medicare Medi Cal Low Income Premium Payment (Buy-In) Program
- FAQ’s CMS.Gov
- Qualified Medicare Beneficiary (QMB)
- CA Health Care Advocates
- dhcs.ca.gov
- Paper Application
- More Info
- National Council on Aging
- Medicare Rights.org
- Effective January 1, 2025, California is now a Medicare Part A Buy-In State
- low-income individuals eligible for Medicare who do not qualify for free Part A due to insufficient work history. will be enrolled in Medicare Part A and the state will pay their Medicare Part A premiums. Learn More – SCAN Broker Bulletin *
- Medicare Savings Programs
- Medicare Medi Cal Low Income Premium Payment (Buy-In) Program
- If you qualify for Medi Cal, Medi Cal might pay your Medicare Premiums
- Misc Resources & Links
Part A #late enrollment penalty
If you aren't eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%. You'll have to pay the higher premium for twice the number of years you could have had Part A, but didn't sign up.
If you were eligible for Part A and have to pay a premium for 2 years but didn't sign up, you'll have to pay the higher premium for 4 years. Usually, you don't have to pay a penalty if you meet certain conditions that allow you to sign up for Part A during a special enrollment period.
Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period (SEP). If you're covered under a group health plan based on current employment, you have a SEP to sign up for Part A and/or Part B anytime as long as:
- You or your spouse (or family member if you're disabled) is working.
- You're covered by a group health plan through the employer or union based on that work.
You also have an 8-month SEP to sign up for Part A and/or Part B that starts at one of these times (whichever happens first):
- The month after the employment ends
- The month after group health plan insurance based on current employment ends
Usually, you don't pay a late enrollment penalty if you sign up during a SEP.
How to apply for Part B during your special enrollment period # 10012
Fact Sheet
Deciding Whether to Enroll in Medicare Part A and Part B When You Turn 65 15 pages
COBRA and retiree health plans aren't considered coverage based on current employment. You're not eligible for a Special Enrollment Period when that coverage ends. This Special Enrollment Period also doesn't apply to people who are eligible for Medicare based on having End-Stage Renal Disease (ESRD).
If you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP) based on your or your spouse’s current employment, you may be eligible for an SEP. To avoid a tax penalty, you should stop contributing to your HSA at least 6 months before you apply for Medicare. You can withdraw money from your HSA after you enroll in Medicare to help pay for medical expenses (like deductibles, premiums, coinsurance or copayments).
Get an estimate of your Medicare eligibility date.
Learn how to sign up for Medicare if you have coverage through the Health Insurance Marketplace.Copied from Medicare.Gov
Qualification for FREE Part A Hospital
How to get Zero Premium Medicare Part A – Hospital
You can get Medicare Part A Hospital at NO PREMIUM if you have 40 quarters of coverage (QCs) and file an application based on your earnings or those of a spouse, parent, or child.
The exact number of QCs (quarters) required is dependent on whether the person is filing for Part A on the basis of
- age,
- disability, or
- End Stage Renal Disease (ESRD).
Coverage quarter are earned through payment of payroll taxes under the Federal Insurance Contributions Act Wikipedia (FICA) during the person’s working years.
Most individuals pay the full FICA tax so the quarters you earn can be used to meet the requirements for both monthly Social Security benefits and premium-free Part A. Medicare & You Handbook – and Enrolling in A & B See link in side panel *
You may also be able to get Part A paid for by Medi Cal Read More Insure Me Kevin.com
See FAQ’s below on how to buy Covered CA or buy Medicare if you don’t have No Premium part A
One spouse did not work and pay into Medicare for the 40 quarters.
Can they apply under their spouses entitlement?
If you’re at least 62 and have worked at least 10 years in Medicare-covered employment, your spouse can get Part A and Part B at 65.
If you’ve worked at least 10 years in Medicare-covered employment but aren’t yet 62 when your spouse turns 65, they won’t be eligible for premium-free Part A until your 62nd birthday. In this case, your spouse should still apply for Part B at 65, so they can avoid paying a higher Part B premium.
However, if you’re still working and your spouse is covered under your group health plan, they could delay their Part B enrollment without paying higher premiums. Publication 11036
Web Visitor Q & A
What about qualifying on my spouses work history?
How to earn Social Security – Medicare Credits Publication # 10072
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What every woman should know - # 10127
FAQ’s
- Question I am 65 with insufficient credits for Social Security benefits. My younger husband is 60 and both covered under his group health insurance, including a “credible” Part D.
- #1) My understanding from various call and office visits to Social Security is that I do not sign up for Social Security until my husband applies at 65.
- #2) Since I am fully covered by his group health insurance, I do not apply for Medicare until he applies for his Social Security at which time I would apply for spousal benefits?
- Is there something I should be doing before I turn 65 to avoid penalties later?
.
- Answer Thanks for your question. It prompted us to spend several hours updating our website to be more helpful to the public.
- How many employees are at your husbands work?
- More or less than 20?
- This new webpage should answer your questions. If not, post your question in the comment section at the bottom of the most relevant webpage.
- See the other faq’s. You can qualify for Medicare on your husbands account, once he turns 62.
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- Question My father and mother have had Covered CA Silver 94 PPO plan, with APTC since ACA went into effect. Their income is below FPL but through two years of consecutive appeals hearing, the Judge had ordered Covered CA that they are eligible for APTC since they are not eligible for non-MAGI Medi-Cal (since both my dad and mom are above 65, and have assets more than Medi-Cal limits, and they cannot spend down).
- Both my dad and mom have been legal permanent residents (green card) at the time of the appeals in 2016 and in 2015. They are eligible for Medicare but are not eligible for premium-free Medicare, and Covered CA did send them a letter stating that people who are not eligible for premium-free Medicare and who don’t enroll in Medicare could be eligible for APTC.
- Just like last two years, again for 2017, Covered CA has told them that we are not eligible for APTC for 2017 coverage. My dad became a US citizen late 2016. But they continue to be ineligible for Medi-Cal, or premium-free Medicare. And without APTC, they cannot afford to get an affordable minimum qualified health plan.
- They have filed for an appeal, but if you can point us to any sections of the ACA, or Federal Code of Regulations or California regulations, or special rules/clarifications, or IRS notes that we can represent to the judge during our hearing, it would be really helpful.
- It is strange that while they would be eligible for APTC as non-citizen aliens (as decided by the Judge last 2 years), their becoming a citizen makes it worse for them.
.
- Answer See our page on Covered CA over 65 if not eligible for premium Free Medicare
- Question Steve,
I have a few questions that I have numbered below for convenience. - Regarding the sign up on the Social Security site, I understood from your email last week that I should sign up for:
- 1. Medicare parts A and B.
- 2. But should I also sign up for part D?
- 3. What about Medigap?
- 4. When do I sign up for part C (Advantage)?
- 5. Once I sign up for Medicare can I start my coverage with the Blue Shield 65 Plus (HMO) plan effective April 1, 2016? If not, when will that coverage start?
- 6. Once that coverage begins, do I pay for it until Bruce turns 62 in October?
- 7. Also, have you heard from Blue Shield yet?
- Please try to answer today if you can so that I can try to sign up today.
.
- Please try to answer today if you can so that I can try to sign up today.
- Answer
- 1 That’s correct
- 2 No, as you were getting the Blue Shield Medicare Advantage Plan. It includes Part D, Rx. Use the menu above to learn more about the Blue Shield and other plans.
- 3 Medicare Advantage is pretty comprehensive and highly regulated. It’s my understanding an agent can go to jail if they sell you a Medi Gap plan in addition to a Medicare Advantage plan, as you don’t need the additional coverage.
- 4 As soon as you get Part B, that should give you a new enrollment period into Medicare Advantage – Part C. OOPS!!! One has to check every rule, I don’t see that in Publication 11219 Understanding Medicare C & D Enrollment periods. It’s if you get Part B during the general enrollment period then you get a Medicare Advantage enrollment period. So, if you get your Part A & B NOW, then you can apply by the end of March for a April 1 start date. This MUST be done by the 31st as your 65th birthday was in December. We have your Blue Shield application, just give us your Medicare #.
- 5 Yes. Sign up TODAY and get us the number. At least some PROOF that you’ve signed up and will be effective in April!
- 6 The Blue Shield Medicare Advantage plan has no premium, other than the optional dental. Use the menu above to get the details and disclosures.
- You will always pay for Part B Medicare – Doctor Visits.
- It’s my understanding that once your husband turns 62 then you won’t have to pay the Part A premium of $426/month. Everything I have on buying Part A is on the page above or in the links to Medicare, Social Security and CMS websites.7 I just reemailed them and they agreed that you can pay for Part A or wait till your husband turns 62. If there are Part B late enrollment penalties, Blue Shield doesn’t do that. Social Security assesses them. The late enrollment penalty calculator also shows Part A premium and when one is eligible.
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- Question My 82-year-old mom came to live in the United States this year and got her green card in July 2013.
She is not eligible for Medicare since she has never worked/paid taxes in this country.- How much will it cost to insure her?
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- How much will it cost to insure her?
- Answer Most immigrants who are “lawfully present,” including people with permanent resident status (also known as green card holders), can buy coverage on Covered CA. No extra charge to use an agent. Just like citizens, they are also eligible for premium tax credits and cost-sharing assistance if they meet the income requirements. (In fact, most legal immigrants must have coverage by 2014, unless they qualify for an exemption.)
- See our page on Covered CA over 65 if not eligible for premium Free Medicare
- As a green card holder, your mother will be eligible for Covered CA , but will need to live here for five years to qualify for Medi-Cal. Since she is not eligible for Medicare, however, she can apply for a premium tax credit, said Lynn Quincy, a senior policy analyst at Consumers Union. New York Times
.
- Question I have less than 40 Social Security quarters and I will have to pay a premium for Part A, Part B and Part D.
Can I buy a health plan from Covered California?
. - Answer See our page on Covered CA over 65 if not eligible for premium Free Medicare
. - Question How long must one live in the USA to be able to buy into Medicare?
. - Answer An individual must be a U.S. resident and either a citizen, or an alien lawfully admitted for permanent residency who has resided in the U.S. continuously for at least 5 years as of the time the application is filed. persons desiring Premium-Part A can only file for coverage during a prescribed enrollment period (see the discussion under Medicare Part B) and must also enroll or already be enrolled in Part B. CMS.Gov
- Medicare Eligibility Calculator
- Don’t have 5 years? ACA/Obamacare Quotes
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- Question I’m self employed and haven’t filed taxes for years. What is the procedure to file late returns so I can show my 40 quarters? What do I do?
. - Answer file an extension it’s October 15th? Turbo Tax
- In 2019, you receive one credit for each $1,360 of earnings, up to the maximum of four credits per year Publication 10072 How you earn credits
- Well, 1st of all, I’m not a CPA and not allowed to give tax advice. Here’s research though, make your own interpretation and check with your CPA, Attorney and/or competent tax counsel.
- There’s a time limit for reporting Social Security earnings and getting credits towards future Social Security benefits. The time period is 3 years, 3 months, and 15 days following the end of the calendar year in which you earn the income. If your earnings are not reported within this time period, you will not accumulate any Social Security credits for the unreported income. Colvin Hallett Law
- The Social Security Administration no longer mails out an annual Social Security Statement. In order to view your Social Security Statement, you must register on the Social Security Administrations website.
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You earn work credits on the minimum $1,360 of earnings no matter when or how frequently you earn them. Theoretically, you could earn four work credits in a single month in which you make $5,440. That would max out your work credits for the year, however. Zacks.com