Medicare Part A is often referred to as “hospital insurance.” This federal government insurance plan mainly helps pay for care when you’re admitted to a hospital or other inpatient facility. It doesn’t cover routine doctor visits or visits with a specialist.
Part A works with Part B (medical insurance) and Part D (prescription drug coverage) to provide the usual coverage you’re used to through your employer health insurance plan or Covered California.
Should I Enroll in Part A?
You don’t have to do so. But it also usually doesn’t hurt to enroll when you’re eligible, for the following reasons:
- You’ve probably already paid Part A with your payroll taxes
- It doesn’t cost you anything extra when you sign up
- Part A could provide supplemental hospital insurance coverage in addition to your employer plan
- To qualify for QMB assistance, you must have Part A and meet income and resource limits. In California, the resource limit for a couple is $195,000.
Enroll in Part A at 65 if:
- You’re retiring at age 65: When you stop working and lose employer coverage, Part A and Part B provide your primary health insurance coverage.
- You receive social security benefits: If you’re already collecting Social Security when you turn 65, you’re automatically enrolled in Part A. You can’t easily opt out of Part A if you’re collecting Social Security benefits. Opting out requires contacting Social Security.
- You don’t have a Health Savings Account (HSA).
- It’s premium-free: If you (or your spouse) worked 10+ years paying Medicare taxes, Part A usually has a $0 monthly premium.
Talk to your employer if your workplace has fewer than 20 employees. If you don’t enroll in Part A when eligible, your employer plan may not fully pay hospital bills.
Who Might Not Enroll
Once you enroll in Medicare (even just Part A), you can no longer contribute to an HSA. Part A coverage can be retroactive for up to 6 months, which can result in tax penalties if you contributed to an HSA during that period.
Delay Part A if:
- You’re still working: If you work for a company with more than 20 employees, your employer’s insurance is considered “creditable coverage” and is primary.
- You have an HSA and want to keep contributing: An HSA can help you save for future medical bills when paired with a high-deductible health plan. If you want to continue contributing to your HSA, you must delay Part A.
- You don’t yet have enough work credits to qualify for free Part A—for example, if you recently immigrated to the U.S.
It’s possible to delay Medicare Part A and enroll later using a Special Enrollment Period after you retire or lose coverage, but consult with a specialist before making that decision.
What Medicare Coverage Does Part A Provide?
Part A mainly covers hospital stays, skilled nursing facility care, hospice, and some home health care.
If you’re admitted to a hospital, a doctor has officially decided you need to stay in the hospital as an inpatient for treatment or monitoring—not just visiting the emergency room.
Hospital Admission
Hospital admission means you’re formally checked in and assigned a hospital bed. Part A helps cover:
- Your hospital room
- Nursing services
- Meals while admitted
- Medications and supplies used during your stay
- Lab tests and imaging were ordered during the admission
Skilled Nursing Facilities
If you have a hospital stay that counts as “qualifying” (usually at least 3 consecutive inpatient days), Part A may cover short-term care in a facility known as a “skilled nursing facility” or SNF. The short-term care could include:
- Physical, occupational, and speech therapy
- Skilled nursing care from nurses specially trained for the facility
- Medical monitoring during your recovery
Home Health Services
Part A can also help cover some home health services if ordered by a doctor. These are part-time or intermittent (not ongoing), and could include:
- Visits from a skilled nurse
- Physical or occupational therapy
- Some medical supplies are used during care
Hospice Care
For people with a terminal illness who choose comfort care for the end of life, instead of continued treatment, Part A’s covered hospice care services include:
- Pain management
- Nursing and support services
- Medical equipment related to the terminal condition
- Counseling and support for the patient and family
What Medicare Coverage Does Part A Not Provide?
- Preventive services and routine doctor visits (that’s typically Medicare Part B coverage)
- Prescription drugs for home use (usually Medicare Part D)
- Permanent nursing home residence (Long-term custodial care)
- Most dental, vision, and hearing services
Part A Premiums and Other Costs
If you worked 40 quarters (about 10 years), you usually get premium-free Part A. Only some people pay a premium for Part A.
For Medicare Part A, “cost sharing” refers to the deductibles and daily coinsurance costs you pay for Part A treatments.
Part A Premium
In general, you’ll pay $0 for Part A if you worked and paid Medicare taxes for 40 quarters (about 10 years).
If you don’t have enough work history:
- $311/month – if you have 30–39 work quarters
- $565/month – if you have fewer than 30 quarters
Hospital Deductible
A deductible is what you pay out of pocket first, before your insurance pays. This is $1,736 per benefit period in 2026. This deductible covers the first 60 days of inpatient hospital care.
A benefit period begins the day you are admitted to a hospital, skilled nursing facility or “inpatient.” It ends when you have gone 60 consecutive days without inpatient hospital care.
If you’re admitted to the hospital again after those 60 days, a new benefit period starts, meaning you pay the $1,736 deductible again.
Hospital Coinsurance
If your hospital stay is longer than 60 days, you will pay coinsurance, much like a copay you may be familiar with from your workplace medical insurance. It’s your portion of the bill.
- Days 61-90: $434/day
- Days 91–150: You use what are called “lifetime reserve days (limited to 60 days in a lifetime). After using these up, you pay all costs.
- Days 91+: $868 per day
Medicare gives you 60 lifetime reserve days to use for very long hospital stays. This means Medicare pays for 140 days in total over your life.
After a qualifying hospital stay, you can stay at a skilled nursing facility (SNF) for up to 20 days for a $0 copay. Starting on the 21st day, you pay $217 per day. After 100 days, you pay all costs.
Medicare Supplement Insurance and Part A Costs
If you choose Original Medicare, buying a Medigap supplemental plan can help cover costs not covered by your Part A plan. For example, Medicare supplemental plans coverage could include:
- Part A coinsurance and hospital costs for up to an additional 365 days after you’ve used your Medicare benefits
- Part A hospice care coinsurance or copayment
- Part A deductible
- Costs for up to 3 pints of blood as a hospital inpatient
Foreign travel emergency (up to plan limits).
Medicare Eligibility for Part A
Let’s break down who qualifies for Part A in plain English. Most people qualify for Part A in one of these ways:
1. Age 65 or Older
You’re eligible at 65 if you:
- Are a U.S. citizen or legal permanent resident (5+ years)
- You or your spouse worked and paid Medicare taxes
If you worked 40 quarters (about 10 years), you usually get premium-free Part A.
If you worked fewer quarters, you can still enroll but must pay a monthly premium.
2. Disability Benefits (Under Age 65)
You can qualify earlier if you:
- Receive disability benefits from Social Security Disability Insurance or the Railroad Retirement Board for 24 months.
After 24 months of continuous disability benefits, you are automatically enrolled in Medicare, including Part A.
3. Certain Medical Conditions
Some people qualify earlier without the 24-month wait, such as those with:
- End-Stage Renal Disease
- Amyotrophic Lateral Sclerosis
For ALS, Medicare usually begins immediately when disability benefits start.
Enrolling in Part A
Automatic Enrollment
You’ll automatically be enrolled if you are already receiving Social Security or Railroad Retirement benefits. Enrollment typically happens around your 65th birthday. You’ll receive a Medicare card in the mail.
Initial Enrollment Period (IEP)
If you are not yet receiving Social Security, you must sign up for yourself. Even if you plan to keep working after 65, many people still sign up for premium-free Part A—unless they’re contributing to an HSA.
This is the main enrollment window. It lasts 7 months total:
- 3 months before your 65th birthday
- Your birthday month
- 3 months after your 65th birthday
Signing up before your birthday month helps coverage start sooner. You can apply through the Social Security Administration website, by phone, or at a Social Security office.
General Enrollment Period (GEP)
If you miss your initial chance, this Medicare Part A enrollment period runs January 1 through March 31 each year. The coverage begins later in the year.
Special Enrollment Period (SEP)
You may delay enrollment without penalty if you had qualifying employer coverage when you were working. When that coverage ends, you get an 8-month window to enroll. Other ways to qualify for the SEP include:
Late Enrollment Penalty
While Part A isn’t generally required, you could face late enrollment penalties if you delay enrollment without qualifying coverage. If you have to pay for Part A and enroll late, your monthly premium increases by 10%.
If your Part A premium is $565/month, the penalty adds $56.50/month.
However, unlike other penalties, the Part A penalty doesn’t last for your lifetime. You only pay the penalty for twice the number of years you delayed enrollment. For example, if you delayed enrollment for two years, you pay for four years.
The Medicare Advantage Plan Alternative
Medicare Advantage offers an alternative to Original Medicare as “Part C.” Medicare Advantage plans combine Part A, Part B, and Part D into one Medicare plan. You can purchase these plans online or from a broker like me—we can help you compare many plans for you to consider.
It’s important to think carefully about whether you want to keep Original Medicare’s Plan A or use a Medicare Advantage plan. Original Medicare (Part A) allows you to go to any hospital in the U.S. that accepts Medicare, which can be beneficial for frequent travelers. However, as noted above, you may pay high out-of-pocket costs without supplemental insurance.
On the other hand, a Medicare Advantage plan will only cover hospital visits within the plan’s local network—except in emergencies. But an MA plan may offer greater cost predictability and other benefits, such as dental cleanings and a gym membership.
Prescription Drug Coverage and Part D (Drug Coverage)
Medications can be covered under Part A if they’re given while you’re in the hospital, in a skilled nursing facility, or in hospice. These could include:
- IV antibiotics for infections
- Anesthesia during surgery
- Anti-nausea drugs
- Medications for pain, anxiety or breathing problems
- Medications given through IV or injection while admitted
You don’t pay separately for each drug—they’re bundled into the hospital coverage.
For other medications—like those you pick up at a pharmacy and take at home—you’ll buy a separate Part D drug plan. Learn more about Part D plans and avoid the Part D late enrollment penalty.