Medicare Part A: Eligibility, Coverage, and Cost
The hospital insurance half of Medicare — what it pays for, what it costs in 2026, and what the coverage gaps are.
Medicare Part A is the hospital insurance half of Original Medicare.
It helps cover inpatient hospital stays, skilled nursing care, hospice, and limited home health services.
Most people get it automatically at 65, and most pay no premium for it — but that doesn't mean it's free of costs.
Medicare Part A serves as the foundation of your Medicare coverage, protecting you from the potentially high cost of inpatient hospital care and other facility-based services.
Here's what it covers, what it costs in 2026, and where the coverage gaps are.
Medicare Part A at a Glance
- Covers inpatient hospital care, skilled nursing facility care (after a qualifying hospital stay), hospice, and limited home health services
- Usually premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years
- Does not cover routine dental, vision, hearing, or outpatient care
- Pairs with Medicare Part B (outpatient care) to form Original Medicare
- Has deductibles and coinsurance with no annual out-of-pocket cap — many people pair it with a Medigap plan
Medicare Terms, in Plain English
A few words that come up a lot below — worth knowing before you dive in.
Who Is Eligible
Most people qualify for premium-free Part A at 65 if:
- They're already receiving Social Security or Railroad Retirement Board benefits, or
- They or their spouse paid Medicare taxes for at least 10 years (40 quarters)
Before age 65, you may qualify early if you:
- Have received Social Security Disability Insurance (SSDI) for at least 24 months
- Have ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's disease) — coverage starts immediately
- Have End-Stage Renal Disease (kidney failure) requiring dialysis or a transplant
You'll also need to be a U.S. citizen or a lawful permanent resident of at least 5 continuous years.
If you don't qualify through your own work record, you may still qualify through a spouse's, or you can purchase coverage.
To confirm your status, check your account at ssa.gov or call 1-800-MEDICARE.
Enrollment Periods
Missing your window costs money.
If you owe a premium and delay enrollment without qualifying coverage, you'll pay a 10% penalty on your premium.
That penalty applies for twice the number of years you delayed enrolling.
You can enroll online, by calling the SSA at 1-800-772-1213, or at a local Social Security office.
See our guide to Medicare Enrollment Periods for a full breakdown of every window and deadline.
Can You Delay Medicare Part A?
Some people delay Part A so they can continue contributing to a Health Savings Account.
This usually applies to someone who is still working, has qualifying employer coverage through a high-deductible health plan, and has not started receiving Social Security benefits.
Once your Medicare coverage begins, you can no longer contribute to an HSA.
Premium-free Part A may also be retroactive for up to six months when you enroll later.
However, it cannot begin before the month you became eligible for Medicare.
For that reason, people planning to enroll in Medicare should generally stop making HSA contributions at least six months beforehand.
If you are already receiving Social Security benefits, you will generally be enrolled automatically in premium-free Part A.
Declining or dropping premium-free Part A can be complicated and may require withdrawing from Social Security benefits.
By contrast, people who pay a premium for Part A can generally choose to drop it.
Before you decide: Speak with Social Security, a tax professional, or a financial advisor before delaying Medicare or continuing HSA contributions.
Medicare confirms that premium-free Part A can begin retroactively by as much as six months, which is the critical HSA issue.
What Medicare Part A Covers
| Covered | Not Covered |
|---|---|
| ✓Inpatient hospital care (semi-private room, meals, nursing, meds, tests) | ✕Outpatient surgery or observation-status stays |
| ✓Skilled nursing facility care, generally after a qualifying three-day inpatient hospital stay | ✕Long-term custodial care (help with daily activities only) |
| ✓Limited medically necessary home health services | ✕Round-the-clock home care or meal delivery |
| ✓Hospice care for terminal illness (6 months or less life expectancy) | ✕Room and board at a skilled nursing facility during hospice |
| ✓Inpatient mental health care (190-day lifetime limit in a psychiatric hospital) | ✕Routine dental, vision, or hearing services |
| ✕Private hospital rooms and personal items (phone, TV) | |
| ✕First 3 pints of blood (unless covered by other insurance or Medigap) |
Key qualifying rules to know:
- You must be formally admitted as an inpatient — an overnight "observation status" stay doesn't count, even in a hospital bed.
- Skilled nursing facility coverage generally requires a prior three-day inpatient hospital stay. Certain Medicare programs and Medicare Advantage plans may waive this requirement.
- Home health and hospice both require a doctor's certification of medical necessity.
Part A does not cover
- Routine dental care
- Routine vision care
- Hearing aids
- Outpatient care
- Long-term custodial nursing home care
- Most medical care outside the U.S.
Common Misunderstandings
These are the mix-ups that trip people up most and often lead to surprise bills:
- Observation ≠ inpatient. If you're under "observation status," Medicare treats you as an outpatient, even overnight. That stay is billed under Part B and doesn't count toward the three-day rule for skilled nursing facility coverage.
- Outpatient surgery isn't Part A. Even in a hospital, surgery without formal inpatient admission falls under Part B.
- No dental, vision, or hearing coverage. These are excluded unless directly tied to a covered medical procedure (e.g., a tooth extraction required before heart surgery).
- No coverage outside the U.S. Medicare generally doesn't cover care abroad, with narrow exceptions like emergencies near the Canadian border or on a cruise ship in U.S. waters.
- No long-term custodial care. Part A covers skilled nursing and home health, not indefinite help with bathing, dressing, or eating.
- Coverage isn't unlimited. Deductibles, coinsurance, and excluded items (private rooms, extra meals) can still add up substantially.
What Medicare Part A Costs in 2026
Why is Part A usually free?
Medicare Part A is funded primarily through payroll taxes.
If you or your spouse paid Medicare taxes for at least 40 quarters (10 years), you'll usually qualify for premium-free Part A.
Not sure what "premium," "deductible," or "coinsurance" mean? See the glossary above.
| Cost Item | Amount |
|---|---|
| Premiums | |
| Most people | $0 |
| 30–39 quarters worked | $311/month |
| Fewer than 30 quarters | $565/month |
| Hospital Stay | |
| Inpatient hospital deductible | $1,736 per benefit period |
| Coinsurance, days 1–60 | $0 |
| Coinsurance, days 61–90 | $434/day |
| Lifetime reserve days, 91–150 | $868/day |
| Beyond 150 days | 100% out of pocket |
| Skilled Nursing Facility (SNF) | |
| Coinsurance, days 1–20 | $0 |
| Coinsurance, days 21–100 | $217/day |
| After 100 days | 100% out of pocket |
| Hospice | |
| Drug copay | Up to $5/prescription |
Lifetime reserve days are a one-time bank of 60 days for your entire life — once used, they don't renew.
In other words: think of them as a backup, not a resource you can count on more than once.
Understanding the Benefit Period
Medicare Part A doesn't work on a calendar-year deductible like most private insurance. Instead, it uses benefit periods, and what happens next depends on timing:
You're still in the same benefit period — no new deductible.
The benefit period ends. Your next admission starts a new one — with a new deductible.
This means if you're hospitalized twice in one year with more than 60 days between stays, you could pay the $1,736 deductible twice.
This is one of the main reasons people buy Medigap — to smooth out the unpredictability.
Filling the Gaps with Medigap
Because Medicare Part A has no annual out-of-pocket maximum for hospital costs, many beneficiaries choose a Medicare Supplement (Medigap) plan — commonly Plan G or Plan N — to help pay deductibles and coinsurance.
Medigap requires enrollment in Original Medicare (not Medicare Advantage).
Your six-month Medigap Open Enrollment Period begins the first month you are 65 or older and enrolled in Medicare Part B.
During this period, insurers generally cannot deny coverage or charge you more because of your health.
Bottom Line
Medicare Part A is the foundation of Original Medicare, covering inpatient hospital care, skilled nursing, hospice, and limited home health services — usually at no monthly premium.
But deductibles, coinsurance, and exclusions like dental, vision, and long-term custodial care mean it's rarely the whole picture.
Understanding benefit periods, enrolling on time, and considering a Medigap plan are the three biggest levers for keeping your costs predictable.
FAQs
- Does Part A cover outpatient surgery?
- Does Part A cover nursing homes?
- Does Part A have a deductible?
- Is Part A enough by itself?
- Do I need a referral to use my Medicare Part A benefits?
