What Part A costs in 2026
| Your Medicare-taxed work (or a spouse's) | Monthly Part A premium |
|---|---|
| 40 quarters or more | No premium |
| 30 to 39 quarters | $311 |
| Fewer than 30 quarters | $565 |
A premium is only part of the cost. Everyone with Part A pays the inpatient deductible of $1,736 per benefit period in 2026, plus coinsurance for long stays. If you must buy Part A and sign up late, the premium can go up 10% for twice the number of years you could have had it but didn't. See Medicare Part A.
North Carolina public employees
North Carolina is different from states where teachers and police are outside Social Security. In 2023, 92.7% of North Carolina's state and local government employees had Social Security coverage, according to the Congressional Research Service, and those jobs also pay the Medicare tax. On top of that, federal law has required the Medicare tax for nearly all state and local employees hired or rehired after March 31, 1986. So most North Carolina teachers, state employees and local government workers earn Part A with no premium just as private-sector workers do.
The smaller group to check: people who worked only in a North Carolina public job that wasn't covered by Social Security and who were hired before April 1986. They may qualify through a spouse's record or other jobs, or may have to buy Part A. Your Social Security statement at ssa.gov shows your Medicare-taxed earnings.
State Health Plan retirees: Part A and Part B must both be in effect to enroll in the Plan's group Medicare Advantage Base Plan or Enhanced Plan; without them you're placed in the 70/30 Plan. See State Health Plan retirees and Medicare.
Help paying Part A
If your income and savings are limited, MQB-Q, one of NC Medicaid's Medicare Savings Programs, pays the Part A premium as well as Part B and Medicare cost sharing. Apply through ePASS or your county Department of Social Services, and try the savings programs screener. For help weighing coverage choices, you can request a call from a licensed insurance agent.
Related questions
What does Medicare cost per month in North Carolina?
All the monthly pieces.
How much is Part B in 2027?
Where the 2027 amounts stand.
What is IRMAA?
Income-based premiums.
Sources
- Medicare.gov — Medicare costs (Part A premium)
- CMS — 2026 Medicare Parts A & B premiums and deductibles
- Social Security — Mandatory Medicare coverage for state and local government employees
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961), Table 1
- State Health Plan — Retiring and Medicare presentation, 2026 (Parts A and B requirements)
- NC Medicaid — MA-2252 Non-MAGI income and reserve limits (MQB-Q), effective April 1, 2026 (PDF)
- NC Medicaid — How to apply
More questions in this guide
- How do I lower my IRMAA after I retire?
- How much does Medicare cost per month in North Carolina?
- How much is Medicare Part B in 2027?
- What is IRMAA and will I have to pay it?
Part of the guide: Medicare costs in 2026 for North Carolinians · All questions
Frequently asked questions
My North Carolina public job wasn't covered by Social Security. Can I get Medicare?
Yes. Medicare eligibility at 65 doesn't depend on Social Security benefits. Public employees hired after March 31, 1986 paid the Medicare tax even in jobs without Social Security, and people 65 or older who are U.S. citizens, or lawful permanent residents here at least five years, can buy Part A and Part B.
Can I use my spouse's work record for Part A?
Yes. If your spouse has 40 quarters of Medicare-taxed work, you can get Part A with no premium at 65 based on that record. Divorced spouses married at least 10 years and some widows and widowers can too.
Does North Carolina help pay a Part A premium?
NC Medicaid's MQB-Q program (North Carolina's name for QMB) pays the Part A premium, along with Part B and Medicare cost sharing, for people with income up to 100% of the federal poverty level and limited resources.
Medicare in your North Carolina county
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