Short answer: Yes. You can still get Medicare without 40 quarters of work. There are three ways: qualify on a spouse's, ex-spouse's, or late spouse's record, buy Part A by paying a monthly premium, or qualify through disability if you are under 65. What changes is the price, not the access.
Premium-free Part A takes 40 quarters of coverage, roughly 10 years of Medicare-taxed work. With fewer than that, Part A carries a premium based on how many quarters you did earn.
| Quarters of Medicare-taxed work | 2026 Part A premium | Per year |
|---|---|---|
| 40 or more | $0 | $0 |
| 30 to 39 | $311/month | $3,732 |
| Fewer than 30 | $565/month | $6,780 |
Part B is separate and is never free. The standard 2026 premium is $202.90/month, higher if your income triggers IRMAA.
Option 1: Qualify on a spouse's work record
This is the first thing to check, and the rules are more generous than most people expect. In all three cases below, you must be 65 or older, and the worker must have 40 quarters.
- Currently married: your spouse must be at least 62, and you must have been married at least one year. Your spouse does not have to be retired, drawing benefits, or enrolled in Medicare yet.
- Divorced: the marriage must have lasted 10 years or more, and you must now be unmarried. Your ex-spouse must be 62 or older. Their own benefits are not reduced and their consent is not required.
- Widowed: you must have been married at least nine months before your spouse died, and be unmarried now.
A common mix-up: the age 62 requirement applies to the working spouse, not to you. You still have to be 65 to start Part A.
Check your own record first, too
Partial credits matter. Getting from 29 quarters to 30 drops the Part A premium from $565 to $311, a savings of $3,048 a year. Self-employment, farm work, and household work can all count if the taxes were paid. Pull your actual earnings record at ssa.gov/myaccount instead of going from memory.
Option 2: Buy Part A
If nobody's record works, you can purchase Part A directly. To do that you must be 65 or older and either a U.S. citizen or a lawfully admitted permanent resident who has lived in the U.S. continuously for the five years immediately before applying.
Four things to know before you do:
- You cannot buy Part A without also enrolling in Part B. For buy-in enrollees they come as a package, so budget $767.90/month in 2026 at the full Part A rate, or $513.90 with 30 to 39 quarters.
- You can take Part B by itself. That costs $202.90 instead of $767.90 and covers doctors and outpatient care, but it leaves hospital stays uncovered and it blocks you from Medigap and Medicare Advantage, both of which require Parts A and B.
- Nothing is automatic. There is no card in the mail for premium Part A. You have to file an application with Social Security.
- Medigap and Medicare Advantage work normally once you have A and B, including the six-month Medigap open enrollment window with no health questions.
Enroll during your Initial Enrollment Period (the seven months around your 65th birthday) or during the General Enrollment Period, January 1 through March 31, with coverage starting the first of the month after you sign up.
Option 3: Medicare under 65 through disability
Medicare is available before 65 in three situations, though each still involves work credits, either yours or a family member's:
- Social Security Disability Insurance (SSDI): after 24 months of SSDI payments you are enrolled in Medicare automatically. Qualifying for SSDI itself requires work credits, generally 40 with 20 earned in the last 10 years, though fewer are needed at younger ages.
- ALS: Medicare begins the same month SSDI benefits begin, with no 24-month wait.
- End-Stage Renal Disease (ESRD): eligibility can be based on your own work record, or on that of a spouse or parent, so a child or non-working spouse may qualify through someone else.
If you get Medicare before 65 through any of these, you do not pay a Part A premium regardless of quarters.
Do late enrollment penalties still apply?
Yes, and this catches people who assume the rules do not apply to them because Part A is not free for them.
- Part A: 10% added to the premium, paid for twice the number of years you delayed. Two years late means four years at $621.50 instead of $565.
- Part B: 10% for each full 12 months you delayed, and this one lasts for life. Five years late is a permanent 50% surcharge.
Full detail is in Medicare Late Enrollment Penalties (2026).
Never worked in the U.S. at all?
If you have zero U.S. quarters, buying Medicare is often not the cheapest answer, and a lot of families overpay by defaulting to it. Someone who has to pay for Part A generally keeps their eligibility for Marketplace premium tax credits, so a subsidized ACA plan can cost far less than $767.90 a month. Medicare Savings Programs can also pay the Part A premium outright for people with limited income, using a conditional Part A application.
That whole comparison, along with the immigration status rules and the 2025 and 2026 law changes that affect it, is covered here: How can someone over 65 get health insurance if they never worked in the U.S.?
Next steps
- To check eligibility on a spouse's record, contact the Social Security Administration at 1-800-772-1213. Expect to bring documentation such as a marriage certificate, divorce decree, or death certificate, often in person at a local office.
- To see your own quarters, log in at ssa.gov/myaccount.
- To apply for premium Part A and Part B, file with Social Security. Premium Part A is not part of the automatic enrollment process.
Talk to a licensed iHealthAgents advisor, free
Before you commit to a $565 monthly premium, let us check whether a spouse's record, a Medicare Savings Program, or a subsidized Marketplace plan gets you the same coverage for less. We will run your actual numbers.
Prefer to book a time? Schedule a free 30-minute Medicare consultation with a licensed advisor.
- Illinois: 312-726-6565
- Texas: 972-666-0578
You can also reach us at help@ihealthagents.com.
For educational use only. Figures are 2026 amounts published by CMS: Part A premiums of $0, $311, and $565, and a standard Part B premium of $202.90. These change annually, and eligibility is determined by Medicare and the Social Security Administration, not by us.
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