What Is the “Working 10-Year Rule” & How Does it Affect Your Medicare Enrollment?

Dear Toni,

Back in February, my husband, James, was laid off and decided to apply for an individual health insurance plan. He’s 62 and can’t apply for Medicare. However, I turned 65 in March and am having a stressful financial issue after enrolling in Medicare. Now, my Medicare is costing me $518 for Medicare Part A and $185 for Medicare Part B, totaling $703 a month! I’m completely shocked and confused. My sister is only paying $185.

Here’s a little background information: I married James 32 years ago and haven’t worked much. I was a stay-at-home mom to our 3 children. I called the 800-number for Social Security, and the representative explained that I had not worked enough time to have Medicare Part A at no cost. She told me that this is my issue.

Please explain what I should do to correct my Medicare problem.

Thank you, Toni,

Wendy from Rosenberg, TX

Hi Wendy,

Sadly, your problem is an all too common one. In fact, many Americans aren’t aware that they must work a certain amount of time and pay employment taxes to receive premium-free Medicare Part A. This is most likely the cause of your problem.

But don’t despair, Wendy—the Toni Says Medicare team helps resolve this issue quite often!

The Medicare.gov website states the following:

• In order to qualify for Medicare Part A at no cost, you must have worked and paid Social Security and Medicare taxes from your payroll checks for ten years, or 40 quarters.
• For 2025, if you have paid Medicare taxes for 30-39 quarters, then the standard Part A premium is $285 each month.
• If a person paid Medicare taxes for less than 30 quarters—the level at which you qualified, Wendy—then the premium for Medicare Part A is $518 per month.
• The extra Part A premium amounts change on January 1st each year, just like Medicare Part B premiums change.

However! ⚠️

Those who do not qualify for premium-free Medicare Part A, but who have:

• Been married to a current or former spouse for at least 10 years, and
• The spouse has met the 10-year requirement

…should apply for Medicare under their working spouse’s Social Security Number!

Wendy, this is your issue. Since you and James have been married for 32 years, you should have applied for Medicare under his Social Security number. Fortunately for you, I have a few steps that might just solve your problem. Wendy and readers in her shoes, keep reading! This next part is especially important for you.

Next steps…

Wendy, my advice to you is this: Contact your local Social Security office. That’s the government entity that enrolls Americans in Medicare. Isn’t it amazing that Medicare does not enroll Americans into Medicare, but Social Security? Your next steps should be:

• Visit Social Security at: www.ssa.gov/manage-benefits/make-an-appointment.
• Schedule an in-person appointment with a Social Security representative. You need to make sure that they process your Medicare properly!
• Ask for assistance in appealing the Medicare Part A premium of $518. Explain that you were a stay-at-home spouse with a husband who’s worked enough quarters to qualify for premium-free Medicare Part A.

Social Security should examine your husband’s Social Security account and verify with the IRS that he has enough quarters to qualify. Be prepared to provide a certified marriage license showing that you and James are married!

⚠️ You will have to bring the original certified marriage license (not a copy) to Social Security! ⚠️

What can those who don’t have a spouse who qualifies do?

Those who:

• Did not work for 10 years or more
• Have never married or lived with someone as a domestic partner, and
• Do not have a certified marriage license

…will have to pay for their Medicare Part A premium!

And if their spouse (or domestic partner) did not work enough quarters, they both will have to pay for their Medicare Part A premiums. Readers, don’t forget the “working 10-year rule” when enrolling in Medicare. And remember—what you don’t know about enrolling in Medicare WILL hurt you!

More Medicare Resources

Have a Medicare question or would like to schedule a Medicare consultation? Call the Toni Says Medicare hotline at 832-519-8664 or email [email protected]. Toni’s new “Confused about Medicare” video series is available at www.tonisays.com.

For more great articles like this one, visit our Medicare Blog!

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