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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.
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Mar 24, 2022
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Medicare Part A is the portion of Medicare that covers hospital care and related services. Unlike the other parts, it’s usually available without a premium. Here’s what to know.
What Medicare Part A covers
Original Medicare — the government-run part of Medicare that you enroll in through Social Security — is made up of two parts: Medicare Part A and Medicare Part B.
While Part B generally covers doctor's appointments and preventive care, Medicare Part A is hospital insurance and typically covers costs in four specific areas.
1. Inpatient hospital care
Part A covers hospital services you get when you’re admitted to a hospital on doctor’s orders, including semiprivate 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 — generally, 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.
2. Skilled nursing facility care
Part A covers your short-term care at a certified skilled nursing facility following a qualifying inpatient hospital stay of at least three days. 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.
Swing bed services.
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. Part A covers all costs for a wide range of support care, pain medications and symptom management to make the patient more comfortable. All medical team members are covered under the Part A hospice benefits as well. The exact plan for care is determined by the hospice doctor and your medical doctor. 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.
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.
You may qualify for premium-free Medicare Part A if you or your spouse has worked and paid Medicare taxes for at least 10 years, earning 40 quarters. To determine your eligibility, use Medicare's eligibility calculator.
If you don't qualify for premium-free coverage, you may be eligible to purchase Part A coverage. If you must pay for Part A, the premium is as much as $499 per month in 2022, 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.
Once you have your Part A plan in place, there are still other costs based on how you use the health care system. 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 instead.
Services
Costs*
Inpatient hospital care
$1,556 deductible for each benefit period.
$0 coinsurance per day for days 1-60 of each benefit period.
$389 coinsurance per day for days 61-90 of each benefit period.
$778 coinsurance per day 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
$0 coinsurance 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).
$194.50 coinsurance per day 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 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:
You're age 65 or older.
You've received disability benefits from Social Security or the Railroad Retirement Board for 24 months.
You receive disability benefits because you have Amyotrophic Lateral Sclerosis, also called ALS or Lou Gehrig’s disease.
You have end-stage renal disease and meet certain requirements.
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
Frequently asked questions
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 tax-free 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.
What isn't covered by Part A?
Here's what's not covered in Part A:
Part A's deductibles and coinsurance
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 $1,556 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 for that particular health issue. If your hospital stay exceeds 60 days, you'll have to start paying coinsurance. If you have a second, unrelated health issue, you will pay the $1,556 deductible again.
Outpatient hospital service
These are covered by Part B and include same-day surgeries or emergency services and X-rays ordered by your doctor, for instance.
Long-term care
While Part A covers a limited amount of time spent at skilled nursing facilities, it doesn’t cover long-term care in nursing homes.
Custodial careCustodial care — or help with eating, getting dressed or bathing — isn't covered by Part A.
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 proactively apply for coverage on SSA.gov. But 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 and ends one month earlier.
Special Enrollment Period (if you qualify): This is an eight-month period starting at the month after your or your spouse's or partner's employment ends or the month after losing your qualifying employer insurance, whichever happens first. You can generally qualify for this special enrollment period if you or your spouse are receiving health insurance from a large employer when you turn 65.
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. However, you would have to pay penalties for late enrollment, and your coverage can't start until July 1. 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 over a year for coverage to begin — even if you signed up the following January.
Those who aren’t eligible for a special enrollment period and miss the initial enrollment period are really in trouble, says Votava of Goodcare.
“They’ll not only pay penalties for the rest of their life, [but they'll] have to wait long periods of time — it could be months, a year, or more than a year — before [they're] eligible to start coverage,” Votava says. And in the meantime, she notes, they’ll be covering 100% of their medical costs out-of-pocket.
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. (See first FAQ above for more information.)
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.
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 tax-free 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.
What isn't covered by Part A?
Here's what's not covered in Part A:
Part A's deductibles and coinsurance
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 $1,556 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 for that particular health issue. If your hospital stay exceeds 60 days, you'll have to start paying coinsurance. If you have a second, unrelated health issue, you will pay the $1,556 deductible again.
Outpatient hospital service
These are covered by Part B and include same-day surgeries or emergency services and X-rays ordered by your doctor, for instance.
Long-term care
While Part A covers a limited amount of time spent at skilled nursing facilities, it doesn’t cover long-term care in nursing homes.
— or help with eating, getting dressed or bathing — isn't covered by Part A.
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 proactively apply for coverage on SSA.gov. But 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 and ends one month earlier.
Special Enrollment Period (if you qualify):
This is an eight-month period starting at the month after your or your spouse's or partner's employment ends or the month after losing your qualifying employer insurance, whichever happens first. You can generally qualify for this special enrollment period if you or your spouse are receiving health insurance from a large employer when you turn 65.
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. However, you would have to pay penalties for late enrollment, and your coverage can't start until July 1. 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 over a year for coverage to begin — even if you signed up the following January.
and miss the initial enrollment period are really in trouble, says Votava of Goodcare.
“They’ll not only pay penalties for the rest of their life, [but they'll] have to wait long periods of time — it could be months, a year, or more than a year — before [they're] eligible to start coverage,” Votava says. And in the meantime, she notes, they’ll be covering 100% of their medical costs out-of-pocket.
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. (See first FAQ above for more information.)
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.
