Yes, you can have Medicare Part B without Part A — but only under specific circumstances. Federal law under 42 U.S.C. § 1395o allows people who are not eligible for premium-free Part A to buy Part B on its own, as long as they are 65 or older, a U.S. citizen, or a lawful permanent resident who has lived in the country for at least five continuous years. The key restriction is that this option applies only to people who must pay for Part A because they lack the required work history — not to those who already get Part A for free.
About 99% of Medicare beneficiaries receive Part A at no cost because they or a spouse paid Medicare taxes for at least 40 quarters (10 years). The remaining 1% face a very different situation — one where choosing Part B without Part A becomes a real decision.
Here is what this article covers:
- 🔍 Who qualifies for Part B without Part A and the exact eligibility rules
- 💰 The real costs of choosing Part B alone versus having both parts in 2026
- ⚠️ Late enrollment penalties and how they permanently raise your premiums
- 📋 Step-by-step enrollment process, including forms and timelines
- ⚖️ The Hall v. Sebelius ruling and why people who do qualify for free Part A cannot drop it
What Medicare Part A and Part B Actually Cover
Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Medicare Part B is medical insurance. It covers doctor visits, outpatient care, preventive services, mental health services, durable medical equipment, and lab tests.
These two parts serve different purposes. Part A handles what happens inside a hospital. Part B handles what happens outside a hospital — in a doctor’s office, an outpatient clinic, or at home.
| Coverage Type | Part A (Hospital Insurance) | Part B (Medical Insurance) |
|---|---|---|
| Inpatient hospital stays | ✅ Covered | ❌ Not covered |
| Doctor visits | ❌ Not covered | ✅ Covered |
| Outpatient surgery | ❌ Not covered | ✅ Covered |
| Skilled nursing facility | ✅ Covered (days 1–100) | ❌ Not covered |
| Preventive screenings | ❌ Not covered | ✅ Covered |
| Home health care | ✅ Partially covered | ✅ Partially covered |
| Hospice care | ✅ Covered | ❌ Not covered |
| Durable medical equipment | ❌ Not covered | ✅ Covered |
Understanding this split matters because it explains why someone might want Part B but not Part A. A person who rarely needs hospital care but sees doctors often may view Part B as the more valuable benefit — especially when Part A comes with a premium of up to $565 per month in 2026.
Who Qualifies for Premium-Free Part A (And Who Does Not)
The federal government provides Part A at no cost to anyone who has worked and paid Medicare payroll taxes for at least 40 quarters — which equals 10 years. A spouse’s work history also counts. If your spouse has 40 or more quarters of Medicare-covered employment, you qualify for free Part A as well.
People who do not qualify for premium-free Part A include those who worked fewer than 10 years in Medicare-covered employment, immigrants who arrived later in life and did not accumulate enough work credits, and people who worked in jobs that did not pay into Medicare (such as certain government positions before 1983). These individuals face a choice: pay the Part A premium or skip Part A altogether.
2026 Part A Premium Costs Based on Work History
| Work History (Quarters) | Monthly Part A Premium (2026) | Annual Cost |
|---|---|---|
| 40+ quarters (10+ years) | $0 (premium-free) | $0 |
| 30–39 quarters | $311/month | $3,732/year |
| Fewer than 30 quarters | $565/month | $6,780/year |
Those premiums are steep. A person with fewer than 30 quarters of work history pays $565 every month just for Part A. That is $6,780 per year before any deductibles or coinsurance.
The Federal Rule That Allows Part B Without Part A
The CMS enrollment guidelines spell this out clearly: if you are not eligible for premium-free Part A, you can buy Part B without buying Part A. This is not a loophole. It is a deliberate provision in the Medicare statute.
The rule works in only one direction, though. If you want to buy Part A (meaning you have to pay a premium for it), you must also buy Part B. You cannot have paid Part A without Part B. But you can have Part B without Part A.
| Enrollment Scenario | Allowed? |
|---|---|
| Free Part A + Part B | ✅ Yes (most common) |
| Part B only (no free Part A eligibility) | ✅ Yes |
| Paid Part A without Part B | ❌ No — Part B required |
| Dropping free Part A while keeping Part B | ❌ No — cannot disclaim free Part A separately |
This structure exists because the government wants to make sure people who pay for Part A also have outpatient coverage. But it gives people who cannot afford Part A the option to at least get Part B’s medical coverage on its own.
Eligibility Requirements for Part B Without Part A
To enroll in Part B without Part A, you must meet all of these requirements:
- Age 65 or older
- A U.S. citizen or a lawful permanent resident who has lived in the U.S. continuously for at least 5 years before filing for Part B
- Not eligible for premium-free Part A (fewer than 40 quarters of work history, either personally or through a spouse)
If you meet all three criteria, you can sign up for Part B during your Initial Enrollment Period — the seven-month window that begins three months before your 65th birthday month and ends three months after it.
What Part B Costs in 2026 (Without Part A)
The standard Part B premium for 2026 is $202.90 per month. This is up from $185.00 in 2025 — an increase of $17.90. The annual deductible for Part B is $283 in 2026, up from $257 the year before.
After paying the deductible, Part B covers 80% of Medicare-approved services. The beneficiary pays the remaining 20% as coinsurance. There is no out-of-pocket maximum under Original Medicare, which means costs can add up fast without supplemental coverage like Medigap.
| Part B Cost Type | 2026 Amount |
|---|---|
| Standard monthly premium | $202.90 |
| Annual deductible | $283 |
| Coinsurance after deductible | 20% of approved charges |
| Out-of-pocket maximum | None (under Original Medicare) |
IRMAA: Income-Based Surcharges on Part B
Higher-income beneficiaries pay more than the standard premium through the Income-Related Monthly Adjustment Amount (IRMAA). This surcharge is based on your modified adjusted gross income from two years prior. About 8% of Part B enrollees pay IRMAA.
| Individual Income | Joint Income | Total Monthly Part B Premium (2026) |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90 |
| $109,001–$137,000 | $218,001–$274,000 | $284.10 |
| $137,001–$171,000 | $274,001–$342,000 | $405.80 |
| $171,001–$205,000 | $342,001–$410,000 | $527.50 |
| $205,001–$499,999 | $410,001–$749,999 | $649.20 |
| ≥ $500,000 | ≥ $750,000 | $689.90 |
IRMAA applies regardless of whether you have Part A. If you enroll in Part B only and your income exceeds $109,000 (individual) or $218,000 (joint), you will pay the higher premium.
How to Enroll in Part B Without Part A: Step-by-Step
Enrollment happens through the Social Security Administration (SSA), not through CMS directly. You cannot sign up online for Part B only — this requires direct contact with Social Security.
Step 1: Determine Your Enrollment Period
There are three possible enrollment windows:
Initial Enrollment Period (IEP): This is the best time to enroll. It is a seven-month window centered around your 65th birthday month. Signing up during the first three months of this window means your coverage starts the month you turn 65.
General Enrollment Period (GEP): If you missed your IEP, you can sign up between January 1 and March 31 each year. Coverage begins July 1 of that year. A late enrollment penalty will apply.
Special Enrollment Period (SEP): If you delayed enrollment because you or your spouse had group health coverage through current employment, you can sign up without penalty. COBRA and retiree plans do not qualify for a SEP.
Step 2: Contact Social Security
Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) or visit your local Social Security office. Explain that you want to enroll in Part B only because you are not eligible for premium-free Part A.
Step 3: Complete CMS-40B (Application for Enrollment in Medicare Part B)
This is the official form for Part B enrollment. You will need to provide your name, Social Security number, date of birth, and information about any current health coverage. If you are enrolling during a SEP, you will also need to fill out CMS-L564, which your employer completes to verify group health plan coverage.
Step 4: Pay Your Premium
Part B premiums are typically deducted from Social Security benefits. If you do not receive Social Security, Medicare will bill you directly — usually on a quarterly basis. You can also sign up for Medicare Easy Pay, which automatically deducts premiums from your bank account.
Three Real-World Scenarios: Part B Without Part A
Scenario 1: Maria — The Immigrant With Limited Work History
Maria moved to the United States from Colombia at age 55. She worked part-time for 8 years, earning only 24 quarters of Medicare-covered employment. At 65, she is not eligible for premium-free Part A.
Maria’s full Part A premium would be $565 per month — a cost she cannot afford on a fixed income. She enrolls in Part B only at $202.90 per month to cover doctor visits, preventive care, and outpatient services.
| Maria’s Decision | Financial Outcome |
|---|---|
| Enrolls in Part B only during IEP | Pays $202.90/month for outpatient coverage |
| Skips Part A to avoid $565/month premium | Saves $6,780/year but has no hospital coverage |
| Seeks Medicaid assistance for hospital costs | May qualify for QMB or SLMB programs |
Scenario 2: James — The Self-Employed Consultant
James worked as a self-employed consultant for 35 years but never paid self-employment tax on his Medicare earnings correctly. He has only 28 quarters. At 65, he discovers he must pay for Part A.
James enrolls in Part B during his Initial Enrollment Period. He also purchases a private hospital indemnity plan to cover potential inpatient costs. His Part B covers doctor visits, diagnostic tests, and outpatient procedures.
| James’s Decision | Financial Outcome |
|---|---|
| Enrolls in Part B only | Pays $202.90/month |
| Buys private hospital indemnity plan | Adds ~$150–$300/month for hospital coverage |
| Total monthly cost | ~$353–$503/month (vs. $767.90 for both Part A and Part B) |
Scenario 3: Susan — The Spouse Who Never Worked
Susan was a stay-at-home parent for her entire adult life. Her husband, Robert, worked for 42 years and has 168 quarters. Susan qualifies for free Part A through Robert’s work history. She cannot enroll in Part B without Part A because she is already entitled to premium-free Part A.
| Susan’s Situation | Rule That Applies |
|---|---|
| Husband has 40+ quarters | Susan gets free Part A through spousal benefit |
| Susan wants Part B only | Not allowed — she already qualifies for free Part A |
| Susan must enroll in both or neither | Part B-only option does not apply to her |
This is the critical distinction. Part B without Part A is only for people who do not qualify for free Part A.
The Hall v. Sebelius Ruling: Why You Cannot Drop Free Part A
In Hall v. Sebelius (2012), three retired federal employees — Brian Hall, John Kraus, and Dick Armey — challenged a federal policy that prevented them from dropping Medicare Part A without also giving up their Social Security retirement benefits. They preferred private insurance and argued that Medicare Part A interfered with the scope of their private coverage.
The D.C. Circuit Court ruled against the plaintiffs. The court held that the Medicare statute does not allow eligible individuals to disclaim entitlement to Part A benefits. Because Part A entitlement is automatic for anyone receiving Social Security, the only way to drop Part A is to repay all Social Security benefits received and forfeit future payments — roughly $280,000 for the plaintiffs.
The Supreme Court declined to hear the case, letting the lower court ruling stand. This means that to this day, anyone entitled to premium-free Part A cannot opt out of it without abandoning Social Security entirely.
What Hall v. Sebelius Means for Part B-Only Enrollment
| Situation | Can You Enroll in Part B Only? |
|---|---|
| You have 40+ quarters and receive Social Security | ❌ No — Part A is automatic and cannot be dropped |
| You have fewer than 40 quarters and no spousal benefit | ✅ Yes — you may buy Part B without Part A |
| You want to drop free Part A to use only private insurance | ❌ No — must also forfeit all Social Security benefits |
The Part B Late Enrollment Penalty: A Permanent Price Increase
Missing your Initial Enrollment Period for Part B triggers a late enrollment penalty that lasts for as long as you have Part B. This is not a one-time fee. It is a permanent increase to your monthly premium.
The penalty is calculated at 10% of the standard premium for each full 12-month period you were eligible but did not enroll. The 2026 standard premium is $202.90.
Penalty Calculation Example
A person who delays Part B enrollment by 3 full years (36 months) would face a 30% penalty:
| Calculation Step | Amount |
|---|---|
| Standard 2026 Part B premium | $202.90 |
| Penalty percentage (3 years × 10%) | 30% |
| Penalty amount ($202.90 × 30%) | $60.87 |
| Total monthly premium | $263.77 (rounded to $263.80) |
That extra $60.87 per month — $730.44 per year — never goes away. It adjusts each year as the standard premium changes, but the 30% surcharge remains permanent.
When the Penalty Does Not Apply
The penalty does not apply if you delayed enrollment because you had group health coverage through current employment (yours or a spouse’s). This qualifies you for a Special Enrollment Period. COBRA coverage, VA benefits, TRICARE, and Marketplace plans do not count as current employer coverage and will not protect you from the penalty.
The Part A Late Enrollment Penalty (If You Later Add Part A)
If you initially skip Part A and later decide to buy it, you may face a separate Part A late enrollment penalty. This penalty is 10% of the Part A premium, and you pay it for twice the number of years you could have had Part A but did not.
A person who was eligible for Part A (with premium) for 4 years but did not sign up would pay a 10% higher premium for 8 years. With the 2026 full Part A premium at $565/month, that penalty adds $56.50/month for 8 years.
HSA Considerations: Why Some People Delay Part A
Some people who are still working past 65 choose to delay all Medicare enrollment to keep contributing to a Health Savings Account (HSA). Under IRS rules, you cannot contribute to an HSA once you are enrolled in any part of Medicare — including Part A.
Because Part A coverage can be retroactive for up to 6 months, a person who signs up for Social Security after 65 could accidentally trigger Part A enrollment retroactively, creating an HSA contribution problem. This is why some people who want to keep their HSA active delay both Part A and Part B.
If you delay Part A because of HSA contributions and you are eligible for free Part A, you can enroll in Part A later with no penalty. Part B, however, must be enrolled in during an IEP or SEP to avoid the permanent late enrollment penalty.
Medigap and Medicare Advantage: What You Cannot Get With Part B Only
Medicare Advantage (Part C)
Medicare Advantage plans require enrollment in both Part A and Part B. If you have Part B only, you cannot join a Medicare Advantage plan. This is a significant limitation because Advantage plans often include prescription drug coverage, dental, vision, and out-of-pocket maximums that Original Medicare lacks.
Medigap (Medicare Supplement Insurance)
Medigap policies are designed to cover the gaps in Original Medicare — things like Part B coinsurance, Part A deductibles, and excess charges. Most Medigap plans assume you have both Part A and Part B. Without Part A, the hospital-related benefits of a Medigap plan would have nothing to supplement.
Some states — including New York, Connecticut, and Massachusetts — have unique Medigap rules, such as guaranteed-issue periods outside the federal standard. Even in those states, having only Part B limits which Medigap benefits are useful to you.
Assistance Programs That Can Help Pay for Part B (and Part A)
If you have limited income and cannot afford Medicare premiums, federal and state programs may help. These are administered through state Medicaid offices but follow federal guidelines.
| Program | Income Limit (2026 approx.) | What It Covers |
|---|---|---|
| Qualified Medicare Beneficiary (QMB) | ≤ 100% FPL | Part A premium, Part B premium, deductibles, coinsurance |
| Specified Low-Income Medicare Beneficiary (SLMB) | 100–120% FPL | Part B premium only |
| Qualifying Individual (QI) | 120–135% FPL | Part B premium only |
| Qualified Disabled and Working Individuals (QDWI) | ≤ 200% FPL | Part A premium only |
The QMB program is especially valuable for people who need both Part A and Part B but cannot afford either premium. It covers both premiums plus cost-sharing amounts.
Mistakes to Avoid When Enrolling in Part B Without Part A
Mistake 1: Assuming COBRA counts as employer coverage for SEP purposes. COBRA is not considered coverage based on current employment. If you rely on COBRA and miss your IEP, you will face a late enrollment penalty and may have to wait until the next General Enrollment Period.
Mistake 2: Waiting too long and missing the IEP entirely. The seven-month Initial Enrollment Period is your best window. Missing it means waiting until the General Enrollment Period (January–March), with coverage not starting until July 1 — creating a gap of several months without any coverage.
Mistake 3: Thinking you can join Medicare Advantage with Part B only. Medicare Advantage requires both Part A and Part B. Without Part A, your only option is Original Medicare (Part B alone), plus any private supplemental plans you can find.
Mistake 4: Not checking spousal work history. Many people who think they must pay for Part A actually qualify for free Part A through a spouse’s work record. Before deciding on Part B only, verify your spouse’s quarters with Social Security.
Mistake 5: Ignoring Medicaid assistance programs. Programs like QMB and SLMB can pay your Part A and Part B premiums if your income is low enough. Enrolling in Part B only without exploring these options could mean paying premiums you did not have to pay.
Pros and Cons of Having Part B Without Part A
| Pros | Cons |
|---|---|
| Saves $311–$565/month by skipping Part A premium | No hospital coverage under Medicare |
| Covers doctor visits, outpatient care, and preventive services | Cannot join Medicare Advantage plans |
| Lower total monthly cost than having both Part A and Part B | Medigap plans offer limited value without Part A |
| Allows access to Medicare’s negotiated rates for outpatient care | No skilled nursing facility or hospice coverage |
| Can still qualify for Medicare assistance programs (SLMB, QI) | A hospital stay without Part A can cost tens of thousands of dollars |
| Part B premium ($202.90/month) is more affordable than many private plans | Part A late enrollment penalty applies if you add Part A later |
Do’s and Don’ts for Part B-Only Enrollment
Do’s
- Do enroll during your Initial Enrollment Period to avoid the permanent late enrollment penalty
- Do check your (and your spouse’s) work history with Social Security before deciding — you may qualify for free Part A without realizing it
- Do explore Medicaid assistance programs like QMB and SLMB that can cover your premiums
- Do consider private hospital indemnity insurance to fill the gap left by skipping Part A
- Do contact Social Security at least 3 months before turning 65 to start the enrollment process
Don’ts
- Don’t assume you can drop free Part A if you already qualify — the Hall v. Sebelius ruling makes this impossible without forfeiting Social Security
- Don’t count COBRA or retiree coverage as employer-based insurance for SEP eligibility
- Don’t ignore the Part B late enrollment penalty — it increases your premium permanently by 10% for every full year you delay
- Don’t plan on joining a Medicare Advantage plan with Part B only — it requires both Part A and Part B
- Don’t contribute to an HSA after enrolling in Part B — IRS rules prohibit HSA contributions once any Medicare coverage is active
Key Entities and Organizations
Centers for Medicare & Medicaid Services (CMS): The federal agency under the Department of Health and Human Services that runs the Medicare program. CMS sets premiums, deductibles, and coverage rules each year.
Social Security Administration (SSA): The agency that handles Medicare enrollment. You sign up for Part A and Part B through SSA, not through CMS. SSA also determines your work history and quarters of coverage.
State Health Insurance Assistance Programs (SHIPs): Free counseling services in every state that help people understand their Medicare options. SHIPs can help you decide whether Part B only makes sense for your situation.
Medicaid (state programs): State-run health coverage that can work alongside Medicare. For people with limited income, Medicaid’s Medicare Savings Programs (QMB, SLMB, QI, QDWI) can pay some or all Medicare premiums and cost-sharing.
2025 vs. 2026 Medicare Cost Comparison
| Cost Category | 2025 | 2026 | Change |
|---|---|---|---|
| Part B standard premium | $185.00/month | $202.90/month | +$17.90 |
| Part B annual deductible | $257 | $283 | +$26 |
| Part A premium (30–39 quarters) | $285/month | $311/month | +$26 |
| Part A premium (<30 quarters) | $518/month | $565/month | +$47 |
| Part A inpatient deductible | $1,676 | $1,736 | +$60 |
Every major Medicare cost increased for 2026. CMS attributed the Part B premium increase to projected price changes and higher utilization of medical services.
FAQs
Can I get Part B if I have never worked?
Yes. You can enroll in Part B at age 65 if you are a U.S. citizen or a permanent resident with 5 continuous years in the country, even without any work history.
Do I automatically get Part B when I turn 65?
No — not always. You get Part B automatically only if you are already receiving Social Security or Railroad Retirement Board benefits. Otherwise, you must sign up.
Will I pay a penalty for enrolling in Part B late?
Yes. The penalty is 10% of the standard premium per full 12-month delay and lasts for as long as you have Part B, unless you qualify for a SEP.
Can I join a Medicare Advantage plan with Part B only?
No. Medicare Advantage requires enrollment in both Part A and Part B. Part B alone limits you to Original Medicare only.
Can I drop Part A and keep Part B if I already have free Part A?
No. Under the Hall v. Sebelius ruling, dropping free Part A requires forfeiting and repaying all Social Security benefits received.
Does Part B cover prescription drugs?
No. Part B covers some outpatient drugs administered by a doctor, but most prescription drugs require a separate Part D plan or a Medicare Advantage plan with drug coverage.
Can I enroll in Part B during any month of the year?
No. You can enroll during your IEP, during a SEP if you qualify, or during the General Enrollment Period from January through March each year.
Is the Part B premium deducted from Social Security?
Yes — if you receive Social Security benefits. The premium is automatically deducted from your monthly check. If not, you receive a quarterly bill from Medicare.
Can Medicaid pay my Part B premium?
Yes. Programs like SLMB and QI pay Part B premiums for qualifying low-income beneficiaries. Contact your state Medicaid office to apply.
Does VA coverage count as employer coverage for avoiding the Part B penalty?
No. VA benefits and Marketplace plans are not considered employer group health coverage and do not qualify you for a Special Enrollment Period.
Related reading
- Does Medicare Part B Cover a Skilled Nursing Facility? (w/Examples) + FAQs
- Can You Have Medicare Part B and Private Insurance? (w/Examples) + FAQs
- Can I Have Medicare Part B and Employer Coverage? (w/Examples) + FAQs
- When Should You Sign Up for Medicare Part B? (w/Examples) + FAQs
- Should I Enroll in Medicare Part D? (w/Examples) + FAQs
- Should I Get Medicare Part C or D? (w/Examples) + FAQs
- Is Nationwide Long-Term Care Insurance Worth It? (w/Examples) + FAQs