Medicare Part A: Eligibility, Coverage, and Cost
Medicare is one of the most vital healthcare programs for older adults and individuals with certain disabilities.
At the core of this system lies Medicare Part A, commonly referred to as hospital insurance. It forms the foundation of Original Medicare, helping beneficiaries manage the often-high costs associated with hospital and inpatient care.
In this comprehensive guide, I’ll explore what Medicare Part A covers, the costs involved, who qualifies, and how to enroll.
I’ll also walk you through common misconceptions, the importance of understanding benefit periods, and our recommendations for supplementing Medicare to avoid those gaps in coverage.
Let’s jump in and talk about the details of Medicare Part A.
What Services Does Medicare Part A Cover?
Medicare Part A is one of the two main components of Original Medicare, the government’s traditional healthcare coverage program. The other component is Medicare Part B, which focuses on outpatient care.
Part A specifically provides coverage for inpatient care, including stays in hospitals, skilled nursing facilities, and hospice care. It’s often called hospital insurance because it helps cover the costs of care you receive when you’re admitted to a healthcare facility.
Most people become eligible for Medicare Part A at age 65, and for many, it’s premium-free thanks to payroll taxes paid during their working years. But even when it comes at no cost, it’s important to understand what services it covers and what it doesn’t.
For most Americans, Part A is the first point of entry into the Medicare program. Let’s walk through the different services covered by Part A.
#1. Inpatient Hospital Care
Imagine you suddenly require surgery or intensive medical treatment. If you’re admitted to a Medicare-approved hospital, Part A is your primary layer of protection.
It covers:
- A semi-private room where you’ll recover
- Meals tailored to your dietary and medical needs
- Nursing services provided by registered nurses
- Medications you receive during your stay
- Lab tests, imaging, and other medically necessary hospital services
However, personal convenience items like a phone, television, or a private room (unless deemed medically necessary) are not covered.
The key to qualifying for this benefit is formal admission as an inpatient by your doctor. Observation stays – even if overnight – do not count.
#2. Skilled Nursing Facility Care
Recovery doesn’t always end when you leave the hospital. Sometimes, you need additional medical support before returning home. If you require short-term rehabilitation or skilled nursing services, Part A may help cover this.
To qualify, you must have spent at least three consecutive days as an inpatient in a hospital.
Once you meet this requirement, Medicare covers:
- Skilled nursing care for rehabilitation
- Physical, occupational, and speech therapy
- Medical supplies and certain equipment
- Meals and a semi-private room
Medicare covers up to 100 days per benefit period, with full coverage for the first 20 days. From days 21 to 100, you’ll pay a daily coinsurance ($209.50 in 2025), and after 100 days, coverage ends.
Important: Long-term custodial care (help with daily activities) is not covered unless you receive skilled care.
#3. Home Health Care
Sometimes, the best place to recover is at home, surrounded by familiarity and comfort.
Medicare Part A supports this through home health care benefits, which include:
- Intermittent or part-time skilled nursing care
- Physical, occupational, or speech-language therapy
- Medical social services
- Some durable medical equipment
To qualify, a doctor must certify that you are homebound and in need of skilled care. Additionally, your care must be provided by a Medicare-certified agency.
This benefit does not cover round-the-clock home care, meal delivery, or custodial care unless skilled care is also received.
#4. Hospice Care
When facing a terminal illness, the goal of care shifts from cure to comfort. Hospice services under Part A focus on pain relief, symptom control, and emotional support for patients and families.
To qualify, a physician must certify that the patient has a life expectancy of six months or less, and the patient must agree to forgo curative treatment.
Hospice services include:
- Medications for pain and symptom control
- Medical equipment like wheelchairs and hospital beds
- Counseling and spiritual support
- Respite care for caregivers
Hospice care can be provided at home, in a facility, or in a hospice center. Copays for medications are minimal (typically no more than $5).
#5. Inpatient Mental Health Services
Medicare Part A also provides coverage for inpatient psychiatric care when needed in a hospital or psychiatric facility.
This benefit includes:
- Room and meals
- Nursing care
- Psychiatric and therapeutic services
If care is provided in a psychiatric hospital, there is a lifetime limit of 190 days.
This coverage ensures individuals with severe mental health conditions can access the care they need in a safe, monitored environment.
What Does Medicare Part A Not Cover?
Medicare Part A certainly covers a lot, but some services are not included.
This list only represents some of the most common exclusions:
- Private room in a hospital or skilled nursing facility
- Routine outpatient screenings and diagnostic procedures
- Private nursing care (inpatient or outpatient)
- Hospital luxuries like telephones and televisions
- First 3 pints of blood for a transfusion (Medigap policies may cover this)
- Skilled nursing facility care without an inpatient hospital stay of at least three days
- Room and board at a skilled nursing facility while receiving coverage for hospice
- Hospital services delivered in “observation” status rather than “admitted” status
If you also receive Medicaid, you may have coverage for some of these expenses. Enrolling in a Medicare Supplement plan may also lead to fewer out-of-pocket costs, but more on that later.
Eligibility for Medicare Part A
Understanding whether you’re eligible for Medicare Part A is one of the first – and most important – steps in planning your healthcare in retirement.
Fortunately, eligibility is straightforward for most Americans, but there are several important nuances to be aware of.
General Eligibility at Age 65
Most people become eligible for Medicare Part A when they turn 65 years old. Eligibility is typically automatic if you meet either of the following conditions:
- You are already receiving Social Security or Railroad Retirement Board (RRB) benefits
- You or your spouse paid Medicare taxes for at least 10 years (or 40 quarters)
If you meet these criteria, you’ll be enrolled in premium-free Part A automatically, and your Medicare card should arrive in the mail about three months before your 65th birthday.
Eligibility Before Age 65
Some individuals qualify for Medicare Part A before reaching age 65. This includes people who:
- Have been receiving Social Security Disability Insurance (SSDI) for at least 24 months
- Have been diagnosed with Amyotrophic Lateral Sclerosis (ALS), in which case Medicare starts immediately
- Have End-Stage Renal Disease (ESRD) and require dialysis or a kidney transplant (eligibility rules vary based on specific treatment circumstances)
Citizenship and Residency Requirements
To qualify for Medicare Part A, you must also:
- Be a U.S. citizen, or
- Be a lawful permanent resident who has lived in the U.S. for at least five continuous years
Even if you’re not eligible for premium-free Part A based on your own work history, you may still qualify through a spouse’s work record – or you can choose to purchase coverage.
Confirming Your Eligibility
Because there are various paths to eligibility, it’s wise to confirm your status with:
- The Social Security Administration (SSA)
- Your My Social Security online account (ssa.gov)
- Medicare directly at 1-800-MEDICARE
Knowing your eligibility status early helps you prepare for enrollment and avoid potential late penalties or coverage gaps.
Whether you’re approaching retirement or navigating disability benefits, verifying your Medicare Part A eligibility is a foundational step to securing your healthcare coverage.
How Much Does Medicare Part A Cost?
Many people hear the term “premium-free Part A” and assume that Medicare won’t cost them anything. While it’s true that most beneficiaries pay no monthly premium for Part A, this doesn’t mean Medicare is entirely free.
There are several out-of-pocket expenses tied to Medicare Part A that are essential to understand for proper financial planning in retirement.
Let’s break down the costs.
#1. Premiums
If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), you qualify for premium-free Part A. However, not everyone meets this requirement.
Here’s how it breaks down if you don’t qualify:
- 30–39 quarters of Medicare-covered employment: $285/month
- Fewer than 30 quarters: $518/month
Note: These premiums are set annually by the Centers for Medicare & Medicaid Services (CMS) and are subject to change.
This monthly expense can add up quickly for those who must pay, especially when combined with other Medicare premiums like Part B and Part D.
#2. Deductibles
Before Medicare Part A begins paying for inpatient hospital care, you must first pay a deductible each benefit period.
- Inpatient hospital deductible (2025): ~$1,676 per benefit period
This deductible resets with every new benefit period, which starts when you’re admitted to a hospital and ends after you’ve been out for 60 consecutive days.
If you are hospitalized multiple times a year, you may need to pay the deductible more than once.
#3. Hospital Coinsurance
Once your deductible is met, Medicare pays the full cost of your inpatient hospital stay for a limited time.
After that, you’ll be responsible for daily coinsurance amounts:
- Days 1–60: $0 (fully covered by Medicare)
- Days 61–90: $419/day
- Days 91–150 (lifetime reserve days): $838/day
- Beyond 150 days: You are responsible for 100% of the costs
Lifetime reserve days are a limited resource – you get only 60 for your entire lifetime. Once they are used, they do not replenish.
#4. Skilled Nursing Facility Coinsurance
Medicare also includes coinsurance costs if you require skilled nursing care after a qualifying hospital stay:
- Days 1–20: $0
- Days 21–100: $209.50/day
- After 100 days: You pay all costs
It’s important to note that the need for a skilled level of care triggers this coverage, not long-term custodial care, which is not included under Part A.
#5. Other Costs
While rare, some hospice-related drugs may require a small copayment (up to $5 per prescription).
Additionally, if a hospice patient needs inpatient respite care, there may be a coinsurance charge of 5% of the Medicare-approved amount.
Benefit Period vs. Calendar Year
One of the most frequently misunderstood aspects of Medicare Part A is how it calculates hospital coverage using benefit periods instead of the typical calendar year model used by most private insurance plans.
This distinction is not just technical – it has real consequences for how much you could end up paying for hospital stays throughout the year.
A benefit period begins the day you’re admitted to a hospital or skilled nursing facility (SNF) as an inpatient. It continues until you haven’t received any inpatient hospital or SNF care for 60 consecutive days.
Once that 60-day period passes without new inpatient care, the benefit period ends, and a new one begins if you’re admitted again in the future.
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Why This Matters
Each new benefit period comes with its own deductible and cost-sharing structure.
That means if you’re hospitalized multiple times in one year, and each stay is separated by at least 60 days, you may have to pay the Part A deductible each time.
Let’s consider an example:
Jane is admitted to the hospital in February and discharged in early March. She recovers at home and receives no inpatient care for the next 65 days.
In June, she is hospitalized again.
Because more than 60 days have passed since her discharge, Jane’s second hospital stay begins a new benefit period – and she will owe another Part A deductible.
With Medicare Part A, it’s possible to pay the deductible multiple times in a single year if your hospitalizations are spaced far enough apart.
Quick Summary:
- A benefit period starts the day you’re admitted and ends 60 days after discharge from inpatient care.
- You could have multiple benefit periods (and multiple deductibles) in one year.
- This structure emphasizes the importance of planning, especially for those managing chronic illnesses or requiring frequent hospitalizations.
Understanding the benefit period framework helps you anticipate and manage your out-of-pocket costs.
It’s also a good reason to consider Medigap coverage, which can help cover deductibles and coinsurance associated with each benefit period.
Enrollment Periods for Medicare Part A
Enrolling in Medicare Part A at the right time is essential to avoid lapses in coverage, financial penalties, and unnecessary complications.
Let’s walk through the enrollment windows together.
#1. Automatic Enrollment
Most people are automatically enrolled in Medicare Part A (and Part B) if they are already receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before turning 65.
Your Medicare card should arrive about three months before your 65th birthday, and no further action is needed unless you want to delay Part B.
If you are not receiving Social Security benefits when you turn 65, you’ll need to actively sign up for Medicare through the Social Security Administration.
#2. Initial Enrollment Period (IEP)
This is a 7-month window that includes:
- The three months before your 65th birthday
- The month of your birthday
- The three months after your birthday month
Example: If your birthday is in June, your IEP runs from March 1 to September 30.
Enrolling during the three months before your birthday ensures your coverage starts the month you turn 65. If you enroll later in the window, your coverage may be delayed.
#3. General Enrollment Period (GEP)
If you miss your IEP and don’t qualify for a Special Enrollment Period, you can enroll during the General Enrollment Period, which runs every year from January 1 to March 31.
However, coverage won’t begin until July 1, and you may have to pay a late enrollment penalty if you don’t qualify for premium-free Part A.
#4. Special Enrollment Period (SEP)
You may qualify for a Special Enrollment Period if you delayed Medicare enrollment because you had creditable health coverage through an employer (yours or your spouse’s).
You have an 8-month window to enroll in Medicare Part A (and/or Part B) starting from the month after:
- Your employment ends, or
- Your employer-sponsored coverage ends – whichever happens first
Keep in mind: COBRA and retiree health insurance do not count as creditable coverage for SEP purposes.
Enrollment Resources
Once you’re ready to enroll, you may choose any of the following options:
- Apply online (this is the fastest option). As you prepare to apply, use the Medicare Documentation Checklist to gather the information you need in order for the process to go smoothly.
- Call the Social Security Administration toll-free at 1-800-772-1213 (TTY 1-800-325-0778).
- Visit your local Social Security office. The agency has a Social Security office locator on its website.
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Avoid Penalties:
If you’re required to pay a premium for Medicare Part A and don’t enroll when first eligible, you may incur a late enrollment penalty. This adds 10% to your monthly premium and is charged for twice the number of years you delayed.
Example: If you delayed enrollment for two years, you’ll pay the penalty for four years.
Can You Decline Medicare Part A?
Yes, it is possible to decline Medicare Part A, but doing so is rare and should be approached with caution.
The most common reason someone might consider declining Part A is if they wish to continue contributing to a Health Savings Account (HSA).
Once you enroll in any part of Medicare, including Part A, you can no longer make tax-deductible contributions to an HSA.
When Might Someone Decline Part A?
You might consider delaying or declining enrollment in Medicare Part A if:
- You are still working and covered under an employer-sponsored high-deductible health plan (HDHP) that allows HSA contributions.
- You are not yet receiving Social Security benefits, which would otherwise automatically enroll you in Medicare.
In this situation, declining Medicare Part A allows you to maintain HSA eligibility, which can be an important financial tool for retirement planning.
How to Decline Medicare Part A
If you are automatically enrolled in Medicare and want to decline Part A, you must disenroll through the Social Security Administration (SSA).
This is not a casual decision – it requires submitting a written request and may involve a personal interview with a Social Security representative.
Be aware that if you decline premium-free Part A and decide to enroll later, you could face delays in coverage and financial penalties, especially if you don’t qualify for a Special Enrollment Period.
Consequences of Declining Part A
There are serious consequences to be aware of:
- Loss of retroactive coverage: When you do eventually enroll in Part A, it may be applied retroactively up to six months, potentially disqualifying you from HSA contributions for that period.
- Late enrollment penalties: If you are required to pay a premium for Part A and delay enrollment without creditable coverage, you may be subject to a late penalty.
- Coverage gaps: Declining Part A may leave you vulnerable if you suddenly need inpatient hospital care and don’t have adequate alternative insurance.
For most people, there is little to no advantage in declining Medicare Part A, especially when it’s premium-free. However, if you’re still working and actively managing an HSA, it might make sense in specific circumstances.
Always consult with a Medicare advisor or financial planner before making this decision, as the implications can affect both your healthcare coverage and your retirement savings strategy.
Common Misunderstandings About Medicare Part A
Medicare Part A may seem straightforward, but several nuances can lead to confusion. Misunderstanding how coverage works can result in unexpected costs, service denials, or gaps in care.
Let’s take a closer look at some of the most common misconceptions – and what the truth really is.
Misunderstanding #1: Observation Stays Count as Inpatient Admissions
One of the biggest misconceptions is assuming that if you spend the night in a hospital, you’re automatically considered an inpatient.
However, Medicare only considers you an inpatient if you’re formally admitted to the hospital by a doctor. If you’re under “observation status,” you’re technically considered an outpatient, even if you’re in a hospital bed overnight.
This distinction matters because observation stays:
- Are not covered by Medicare Part A
- Do not count toward the 3-day inpatient stay required for skilled nursing facility coverage under Part A
- Are instead billed under Medicare Part B, which may involve different out-of-pocket costs
Always ask the hospital staff whether you are being treated as an inpatient or under observation.
Misunderstanding #2: Outpatient Surgery is Covered by Part A
Even if your surgery is performed in a hospital setting, if you aren’t formally admitted as an inpatient, it won’t be covered under Part A.
Instead, outpatient surgeries – regardless of where they take place – are billed under Medicare Part B.
This distinction can affect your costs and deductible responsibilities, so it’s important to verify your admission status before a procedure.
Misunderstanding #3: Medicare Part A Covers Dental, Vision, and Hearing Services
Medicare Part A does not provide coverage for most routine dental care, eye exams, or hearing aids. These services are not considered medically necessary in the context of inpatient treatment and are therefore excluded.
Exceptions are rare and only occur when the dental or vision service is part of a covered medical procedure. For example, a tooth extraction needed before heart surgery might be included.
Misunderstanding #4: Medicare Covers International Care
Many beneficiaries assume that their Medicare Part A benefits will travel with them internationally. Unfortunately, Medicare generally does not cover medical care outside of the U.S.
There are very few exceptions, such as when you’re traveling through Canada and a U.S. hospital is closer but unavailable, or when you’re on a cruise and the ship is within U.S. territorial waters.
If you plan to travel abroad, consider purchasing supplemental insurance that includes international coverage.
Misunderstanding #5: Medicare Automatically Covers Long-Term Care
While Part A covers skilled nursing facility stays and home health services, it does not pay for long-term custodial care. If not accompanied by skilled care, services like help with bathing, dressing, and eating are not included.
Many people assume Medicare will pay for nursing home costs indefinitely. In reality, long-term care usually requires separate planning and possibly the purchase of long-term care insurance.
Misunderstanding #6: All Hospital Expenses Are Covered
Medicare Part A covers many inpatient-related costs, but not everything.
You may still be responsible for:
- The deductible for each benefit period
- Daily coinsurance after a certain number of days in the hospital
- Costs for items like personal care supplies, phone or television use, and extra meals
It’s crucial to understand that coverage is not unlimited, and out-of-pocket costs can mount quickly if hospital stays are lengthy or repeated within short periods.
Supplementing Medicare Part A with Medigap
Even with Medicare Part A providing valuable hospital coverage, out-of-pocket costs can be substantial, especially when facing unexpected medical events or repeated hospitalizations.
That’s why many people turn to Medicare Supplement insurance, also known as Medigap, to bridge the coverage gaps.
Why Consider Medigap?
Original Medicare (Part A and Part B) covers many healthcare services, but not all costs. You are responsible for deductibles, coinsurance, and copayments.
Medigap plans are designed to minimize these expenses by filling in those “gaps.”
These policies are especially popular among retirees who want predictability in healthcare expenses and freedom to see any doctor who accepts Medicare nationwide.
What Does Medigap Cover?
While each Medigap plan offers a different level of coverage, many include benefits like:
- The Part A deductible (which is over $1,600 per benefit period in 2025)
- Coinsurance for hospital stays beyond 60 days
- Skilled Nursing Facility (SNF) coinsurance
- Hospice coinsurance/copayments
- Foreign travel emergency coverage (up to 80% in most cases)
- Blood transfusions (first 3 pints)
Popular Medigap Plan Options
Medigap plans are labeled by letters (Plan A, B, D, G, K, L, M, and N), and each offers a standardized set of benefits.
Among the most popular options are:
Plan G: Offers comprehensive coverage, including the Part A deductible and coinsurance. It does not cover the Part B deductible but is often considered the most complete plan available for new enrollees.
Plan N: A lower-cost option with coverage for most essential benefits but with small copays for doctor visits and emergency room visits.
Note: Plan F (which covered both Part A and Part B deductibles) is no longer available to those eligible for Medicare after January 1, 2020.
How Much Does Medigap Cost?
Medigap premiums vary based on several factors:
- Medigap provider
- Plan type
- Your age
- Location and zip code
- Gender and tobacco use
- When you enroll (open enrollment offers the best pricing)
As of 2025, monthly premiums for Plan G can range from $100 to $300, while Plan N may range from $80 to $250, depending on the factors above.
While this may seem costly, many beneficiaries find that the predictability of costs, combined with the freedom to choose any provider who accepts Medicare, makes Medigap a worthwhile investment.
When Can You Enroll in a Medigap Plan?
The best time to enroll is during your Medigap Open Enrollment Period – a six-month window that begins the month you turn 65 and are enrolled in Medicare Part B.
During this time, you cannot be denied coverage or charged more due to pre-existing conditions.
After this period, you may be subject to medical underwriting unless you qualify for a Guaranteed Issue Right due to specific circumstances (like losing employer coverage).
In a nutshell:
- Medigap plans help cover costs that Medicare Part A (and B) do not, providing financial peace of mind.
- Plan G and Plan N are among the most popular and widely available choices.
- Premiums vary but often bring significant savings for people with chronic conditions or frequent hospital visits.
- To buy a Medigap plan, you must be enrolled in Original Medicare (Parts A and B). Medigap cannot be used with Medicare Advantage.
Medigap offers flexibility, security, and broader access to providers, making it an essential companion to Medicare Part A for many retirees.
Bottom Line
Medicare Part A is the foundation of Original Medicare, delivering vital protection against the high costs associated with inpatient hospital care, skilled nursing, hospice, and certain home health services.
For most Americans turning 65, eligibility is automatic and premium-free, as long as they or their spouse paid Medicare taxes for at least ten years. Those with qualifying disabilities or conditions like ALS or ESRD may become eligible even earlier.
Part A provides wide-ranging coverage, from room and board during a hospital stay to rehabilitative care in a skilled nursing facility to essential services during end-of-life hospice care.
However, it does not cover everything. Long-term custodial care, routine dental or vision services, and outpatient treatments fall outside its scope, and observation stays do not meet the same coverage standards as inpatient admissions.
Costs under Part A vary depending on work history. While most beneficiaries won’t pay a monthly premium, others may face charges up to $518 monthly in 2025.
Additionally, the inpatient deductible of approximately $1,676 per benefit period and daily coinsurance rates for extended stays in hospitals or skilled nursing facilities can lead to significant out-of-pocket costs, especially if hospitalizations occur multiple times yearly.
Understanding the benefit period structure is key, as each new period may reset your deductible and cost-sharing responsibilities.
Enrolling in Medicare Part A is usually automatic if you’re receiving Social Security benefits, but if not, it’s important to sign up during your Initial Enrollment Period or a qualifying Special Enrollment Period to avoid penalties. There may be valid reasons to delay enrollment for those still working and contributing to a Health Savings Account, but this should be carefully weighed with a financial advisor.
Because Part A doesn’t cover all your healthcare needs or limit your annual out-of-pocket costs, many beneficiaries choose to pair it with additional coverage. Medigap plans, especially Plans G and N, are popular supplements that can fill in financial gaps left by Original Medicare, offering predictable costs and greater peace of mind.
In short, Medicare Part A is essential, but it’s only one piece of your broader healthcare puzzle. Understanding what it offers (and what it doesn’t) will help you build a more complete and secure Medicare strategy for retirement.
Sources: What Does Part A Cover? | What Does Part A Not Cover? | How to Enroll
FAQs
- Does Medicare Part A cover outpatient surgery?
- Will I lose Part A if I return to work?
- What if I’m admitted to a hospital while traveling in the U.S.?
- What if I’m admitted for observation only?
- Do I need a referral to use my Medicare Part A benefits?
