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Medicare Part A: What It Covers, What It Costs
Medicare Part A is the hospital insurance portion of Medicare. For most people, it’s premium-free.
Claire Tsosie Assigning Editor | Credit cards, business software, payments
Claire Tsosie is an assigning editor for NerdWallet. Her areas of expertise include research and strategy. She has edited articles on a variety of topics, including Social Security, estate planning, Medicare, crypto, business software and home improvement. Previously, she was a credit cards writer at NerdWallet for over five years. Her work was featured by Forbes, USA Today and The Associated Press. She's been a speaker at both CardCon (2017, 2018) and FinCon (2019).
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
Debra Nuckols, a Health Plan Services Consultant at BluePeak Advisors, a Gallagher Benefit Services Inc. division, has been in the managed care industry for 20 years. She specializes in Medicare compliance, corporate compliance, auditing and monitoring, and new-to-Medicare health plan startups. Before becoming a consultant, Debra worked for several national managed care organizations as a Medicare compliance officer, serving as an expert on the matter. In addition to her extensive health plan experience, Debra worked at the Centers for Medicare & Medicaid Services, or CMS, in the Seattle area, where she oversaw national and local Medicare Advantage plans.
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Medicare Part A covers hospital care and related services. Unlike the other parts of Medicare, it’s usually available without a premium. Here’s what to know about Part A coverage and costs.
What Medicare Part A covers
Medicare Part A is hospital insurance and typically covers costs in four specific areas.
1. Inpatient hospital care
Medicare Part A covers hospital services you get when you’re admitted to a hospital on doctor’s orders, including semi-private rooms, meals, general nursing and drugs for inpatient treatments
. If you want care outside of Part A’s coverage, such as a private room or a private-duty nurse, you’re on your own to pay the incremental costs.
It’s also important to note that if you need admittance to a psychiatric hospital for mental health treatment once you’re on Medicare, coverage falls under Part A
. You get fewer days of coverage — up to 190 days over your lifetime.
Fortunately, most hospitals accept Medicare, a criteria for using Part A. Note, however, that Veterans Affairs hospitals and other military hospitals usually take VA and military insurances, not Medicare.
Medicare Part A covers inpatient hospital care in a variety of facilities, including:
Acute care hospitals.
Critical access hospitals.
Inpatient rehabilitation facilities.
Inpatient psychiatric facilities.
Long-term care hospitals.
Inpatient care as part of a qualifying clinical research study.
Shopping for Medicare plans? We have you covered.
MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup.
MEDICARE SUPPLEMENT, or Medigap, is private health insurance that covers “gaps” in traditional Medicare coverage. Compare options from our Medigap roundup.
. Covered services include a semiprivate room, meals, skilled nursing care and physical and occupational therapy when needed.
Most other services needed for your wellness care are also covered, including:
Speech-language pathology services.
Medical social services.
Medications.
Medical supplies and equipment used in the facility.
Ambulance transportation to the closest supplier of needed services that aren't available at your facility (if other transport would endanger your health).
Dietary counseling.
Your medical team may recommend more services outside the scope of Part A. You would be responsible for those costs.
3. Hospice benefits
Hospice is the end-of-life care you receive if you're terminally ill. Medicare Part A covers all costs for a wide range of support care, pain medications and symptom management to make the patient more comfortable. Costs incurred for grief and loss counseling for you and your family as well as respite care for your main caregiver are also included
Whether you're using Original Medicare or a Medicare Advantage plan, Medicare Part A covers the full range of hospice care and costs. Coordinate with your specific insurance plan for entry into hospice.
People on Medicare who are homebound may get certain health care services provided right in their homes. Generally, a doctor must approve the situation and you must use a Medicare-certified agency. Covered services include part-time skilled nursing and home health aide care, occupational therapy, physical therapy, speech-language pathology services, medical social services and injectable osteoporosis drugs for women, among other things
Centers for Medicare & Medicaid Services. Home health services. Accessed Sep 6, 2023.
Use caution when planning for home health services. Medicare doesn't pay for 24-hour-a-day care at home, meal delivery, homemaker services (if that's the only care you need) or personal care — such as bathing or dressing (if that's the only care you need). And there is a lot of research necessary to make sure you know which services are covered under Part A and which ones would be your responsibility.
If you don't qualify for premium-free coverage, you may be eligible to buy Part A coverage. If you must pay for Part A, the premium is as much as $506 per month in 2023 ($505 in 2024), depending on you and your spouse's work and Medicare tax history
“If you’re over 65 and you can afford it, it makes sense to pay for Part A,” says Joseph Schneier, CEO and co-founder of Trusty.care — a Medicare quoting and enrollment tool for brokers — acknowledging that the premiums aren't cheap. “Original Medicare plus a supplement is probably going to be the best insurance you have,” he notes, referring to Medigap plans.
Aside from Part A premiums, there are other costs based on your health care use. The table below summarizes your share of costs when in the hospital or skilled nursing care. Depending on the specifics of your Medigap plan or Medicare Advantage policy, these costs may be covered by that insurance.
Services
Costs*
Inpatient hospital care
$1,600 ($1,632 in 2024)
deductible for each benefit period.
Coinsurance of $0 per day in 2023 for days 1-60 of each benefit period.
Coinsurance of
$400 per day in 2023 ($408 in 2024)
for days 61-90 of each benefit period.
Coinsurance of
$800 per day in 2023 ($816 in 2024)
for days 91 and beyond of each benefit period, up to your total lifetime reserve days (60 days over your lifetime).
All costs after exceeding lifetime reserve days.
Skilled nursing facility care
Coinsurance of $0 per day in 2023 for days 1-20 for each benefit period (which starts on the day you’re admitted and ends when you haven’t received inpatient hospital or skilled nursing facility care for 60 days).
Coinsurance of
up to $200 per day in 2023 ($204 in 2024)
of each benefit period for days 21-100.
All costs for days 101 and beyond.
Hospice
$0 for hospice care.
$5 or less on copayments for prescription drugs for pain relief or symptom relief at home.
5% of Medicare-approved amount for occasional inpatient respite care, in some cases.
Home health services
$0 for covered home health services.
20% of the Medicare-approved amount for certain medical equipment, such as wheelchairs and walkers.
*Your share of Part A costs if you don't have supplemental insurance that covers these deductibles and coinsurance charges.
🤓Nerdy Tip
Other parts of Medicare — including Part C (Medicare Advantage plans), Part D (prescription drug coverage) and Medigap plans — are available through private health insurers approved by Medicare. If you sign up for a Medicare Advantage plan, an alternative to Original Medicare, it will include at least the same coverage provided in Original Medicare. However, you may be limited to a certain network and different rules may apply.
Medicare Part A eligibility
Generally, you're eligible for Medicare Part A if you meet one of the following requirements, according to Medicare:
MEDICARE SUPPLEMENT, or Medigap, is private health insurance that covers “gaps” in traditional Medicare coverage. Compare options from our Medigap roundup.
Does it make sense to enroll in Medicare Part A and postpone the rest?
For those getting health care from a large employer, enrolling in Part A if you qualify for premium-free Part A and delaying the rest until retirement might seem like a smart idea — but there are caveats.
“We used to tell people, go ahead and get into Medicare A, there’s no fee,” says Katy Votava, president of Goodcare, a consulting firm for the management of Medicare costs and planning, and author of the book “Making the Most of Medicare: A Guide for Baby Boomers.” “But you don’t want to enroll in Medicare [Part] A if you have an employer plan that lets you put money into health savings accounts.”
That’s because you won’t be able to make contributions to your HSA while enrolled in Medicare, she notes.
These types of plans — high-deductible health plans with HSAs — have become more common in recent years, Votava notes. Even if you don’t have one now, your company might change its coverage options and you might end up in one before retirement, she adds. If you’re unsure of how your coverage might change, it may be best to wait until your special enrollment period and sign up for parts A and B at the same time.
Does Medicare pay 100% of Part A?
Although Medicare Part A covers a share of your eligible medical costs, you’re still responsible for some out-of-pocket costs unless you have a supplemental plan that covers them.
You’ll have to cover deductibles (and, potentially, coinsurance) if you’re hospitalized or in approved skilled nursing care. That deductible for hospital care is $1,600 per benefit period, which starts on the day you’re admitted and ends when you haven’t received inpatient hospital care or care in a skilled nursing facility for 60 days.
If your hospital stay exceeds 60 days or your skilled nursing facility stay exceeds 20 days, you'll have to start paying coinsurance. If you enter a new benefit period after the previous one ended, you will pay the $1,600 deductible again.
When should I enroll in Medicare Part A?
If you’re already receiving Social Security or Railroad Retirement Board benefits before age 65, you’ll automatically be enrolled in Original Medicare — including both Medicare Part A and Part B coverage — the month you turn 65. If you are waiting to begin Social Security benefits, you can separately enroll in Part A, Part B or both. Regardless of your choice, you must apply for coverage on SSA.gov. But if you're not getting premium-free Part A, getting the timing right can be tricky.
Initial enrollment period, or IEP: This is the seven-month period starting three months before the month you turn 65, including your birthday month and ending three months after your birthday month. If your birthday is on the first of a month, your IEP begins four months before your birthday month and ends two months after.
Special enrollment period (if you qualify): Certain situations or life events will allow you to sign up for Part B and Premium-Part A outside of normal enrollment periods. These events include things like ending health coverage from an employer or missing sign-up due to a natural disaster.
General enrollment period: This runs from Jan. 1 through March 31 every year. If you didn’t sign up when you were first eligible and weren’t eligible for a special enrollment period, you’ll have to wait for the general enrollment period to sign up. Coverage starts the month after you sign up, and you may pay penalties for late enrollment. So, for example, if you were to realize on April 1 that you needed to sign up for Medicare during the general enrollment period, you'd have to wait until January to sign up, and coverage would start in February.
Those who aren’t eligible for a special enrollment period and miss the initial enrollment period could face trouble. They may have to pay permanent penalties for the delay in coverage, and they’ll have to cover their medical costs out-of-pocket while they wait for the next sign-up period.
While there aren’t penalties for Part A if you’re getting it premium-free, there are penalties for enrolling late in Parts B and D, which grow larger the longer you postpone your enrollment. Before turning 65, make sure you understand the type of coverage you'll have available the month you turn 65 and whether you’ll be eligible for a special enrollment period.
If I have employer health insurance, do I have to enroll in Medicare at 65?
The answer depends on the size of your employer.
Enrolling in premium-free Part A and postponing the other parts of Medicare has long been a strategy used by folks to get more coverage at no upfront cost. But it may not work in all cases.
If you have a "small employer" group health insurance plan (defined by Medicare as fewer than 20 employees): In almost all cases, you must enroll in Medicare parts A, B and D — or a Medicare Advantage plan that covers these — when you're first eligible to avoid costly penalties. That means during your initial enrollment period around your 65th birthday month. At age 65, Medicare becomes your primary coverage, meaning it will pay first and most for any health care system costs you incur. Your employer coverage will pay secondary. If you don't have Medicare in place by age 65, you're generally responsible for all costs.
If you have a "large employer" group health insurance plan (20-plus employees): You can generally postpone enrollment in Medicare Parts A and B in this case until well after age 65 with no penalties. Your large group health insurance must continue to cover you and any applicable dependents until you leave the employer. After your coverage ends, you’ll be eligible for a special enrollment period of eight months. During that time you can enroll in Parts A and B, choose your Medigap or Medicare Advantage plan, and your Part D drug plan. But note that until you’re fully enrolled in Medicare, you may not have health insurance.
Before making your decision, confirm the details of your health coverage with your benefits manager.
Is Medicare Part A or B better?
Medicare Part A is your hospital insurance, covering things like an inpatient hospital stay, and Medicare Part B is your medical insurance, covering things like doctor visits and durable medical equipment. They are both parts of Original Medicare and do not compete with each other — they cover different parts of your health care.
Does it make sense to enroll in Medicare Part A and postpone the rest?
For those getting health care from a large employer, enrolling in Part A if you qualify for premium-free Part A and delaying the rest until retirement might seem like a smart idea — but there are caveats.
“We used to tell people, go ahead and get into Medicare A, there’s no fee,” says Katy Votava, president of
, a consulting firm for the management of Medicare costs and planning, and author of the book “Making the Most of Medicare: A Guide for Baby Boomers.” “But you don’t want to enroll in Medicare [Part] A if you have an employer plan that lets you put money into health savings accounts.”
That’s because you won’t be able to make contributions to your HSA while enrolled in Medicare, she notes.
These types of plans — high-deductible health plans with HSAs — have become more common in recent years, Votava notes. Even if you don’t have one now, your company might change its coverage options and you might end up in one before retirement, she adds. If you’re unsure of how your coverage might change, it may be best to wait until your special enrollment period and sign up for parts A and B at the same time.
Does Medicare pay 100% of Part A?
Although Medicare Part A covers a share of your eligible medical costs, you’re still responsible for some out-of-pocket costs unless you have a supplemental plan that covers them.
You’ll have to cover deductibles (and, potentially, coinsurance) if you’re hospitalized or in approved skilled nursing care. That deductible for hospital care is $1,600 per benefit period, which starts on the day you’re admitted and ends when you haven’t received inpatient hospital care or care in a skilled nursing facility for 60 days.
If your hospital stay exceeds 60 days or your skilled nursing facility stay exceeds 20 days, you'll have to start paying coinsurance. If you enter a new benefit period after the previous one ended, you will pay the $1,600 deductible again.
When should I enroll in Medicare Part A?
If you’re already receiving Social Security or Railroad Retirement Board benefits before age 65, you’ll automatically be enrolled in Original Medicare — including both Medicare Part A and Part B coverage — the month you turn 65. If you are waiting to begin Social Security benefits, you can separately enroll in Part A, Part B or both. Regardless of your choice, you must apply for coverage on SSA.gov. But if you're not getting premium-free Part A, getting the timing right can be tricky.
This is the seven-month period starting three months before the month you turn 65, including your birthday month and ending three months after your birthday month. If your birthday is on the first of a month, your IEP begins four months before your birthday month and ends two months after.
Special enrollment period (if you qualify):
Certain situations or life events will allow you to sign up for Part B and Premium-Part A outside of normal enrollment periods. These events include things like ending health coverage from an employer or missing sign-up due to a natural disaster.
General enrollment period:
This runs from Jan. 1 through March 31 every year. If you didn’t sign up when you were first eligible and weren’t eligible for a special enrollment period, you’ll have to wait for the general enrollment period to sign up. Coverage starts the month after you sign up, and you may pay
. So, for example, if you were to realize on April 1 that you needed to sign up for Medicare during the general enrollment period, you'd have to wait until January to sign up, and coverage would start in February.
and miss the initial enrollment period could face trouble. They may have to pay permanent penalties for the delay in coverage, and they’ll have to cover their medical costs out-of-pocket while they wait for the next sign-up period.
While there aren’t penalties for Part A if you’re getting it premium-free, there are penalties for enrolling late in Parts B and D, which grow larger the longer you postpone your enrollment. Before turning 65, make sure you understand the type of coverage you'll have available the month you turn 65 and whether you’ll be eligible for a special enrollment period.
If I have employer health insurance, do I have to enroll in Medicare at 65?
The answer depends on the size of your employer.
Enrolling in premium-free Part A and postponing the other parts of Medicare has long been a strategy used by folks to get more coverage at no upfront cost. But it may not work in all cases.
If you have a "small employer" group health insurance plan (defined by Medicare as fewer than 20 employees):
In almost all cases, you must enroll in Medicare parts A, B and D — or a Medicare Advantage plan that covers these — when you're first eligible to avoid costly penalties. That means during your initial enrollment period around your 65th birthday month. At age 65, Medicare becomes your primary coverage, meaning it will pay first and most for any health care system costs you incur. Your employer coverage will pay secondary. If you don't have Medicare in place by age 65, you're generally responsible for all costs.
If you have a "large employer" group health insurance plan (20-plus employees):
You can generally postpone enrollment in Medicare Parts A and B in this case until well after age 65 with no penalties. Your large group health insurance must continue to cover you and any applicable dependents until you leave the employer. After your coverage ends, you’ll be eligible for a special enrollment period of eight months. During that time you can enroll in Parts A and B, choose your Medigap or Medicare Advantage plan, and your Part D drug plan. But note that until you’re fully enrolled in Medicare, you may not have health insurance.
Before making your decision, confirm the details of your health coverage with your benefits manager.
Is Medicare Part A or B better?
Medicare Part A is your hospital insurance, covering things like an inpatient hospital stay, and Medicare Part B is your medical insurance, covering things like doctor visits and durable medical equipment. They are both parts of Original Medicare and do not compete with each other — they cover different parts of your health care.
