Medicare Part A Explained: What It Covers, What It Costs, and How to Enroll

Medicare Part A is hospital insurance. It covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care. Part A is one of the two main parts of Original Medicare, along with Part B.

Most people do not pay a monthly premium for Part A. If you or your spouse paid Medicare taxes while working, you likely qualify for premium-free coverage. This guide explains what Part A covers, what it costs, and how to enroll.

What Does Medicare Part A Cover?

Medicare Part A helps pay for services you need when you are seriously ill or recovering from surgery. It does not cover routine doctor visits or outpatient care. Here is what Part A covers.

Inpatient Hospital Care

Part A covers inpatient hospital stays when you are formally admitted. This includes your room, meals, nursing care, medications, lab tests, and surgery. It does not cover private rooms unless medically necessary, or personal items like phones and televisions.

You must be admitted as an inpatient for Part A to cover your stay. If you are under observation status, you are considered an outpatient, and Part B applies instead. Ask your doctor or hospital whether you are admitted or under observation.

Skilled Nursing Facility Care

Part A covers care in a skilled nursing facility if you need daily skilled nursing or therapy after a hospital stay. You must have been in the hospital for at least three consecutive days and enter the facility within 30 days of leaving the hospital.

Medicare covers up to 100 days per benefit period. The first 20 days are fully covered. Days 21 through 100 require a daily copayment. Part A does not cover long-term care or custodial care, such as help with bathing or eating.

Hospice Care

Part A covers hospice care for people with terminal illnesses. This includes pain relief, symptom management, medical equipment, counseling, and support services. You can receive hospice care at home, in a hospice facility, or in a hospital.

Your doctor must certify that you are terminally ill with a life expectancy of six months or less. You can choose to stop hospice care at any time and resume regular Medicare coverage.

Home Health Care

Part A covers part-time or intermittent skilled nursing care and home health aide services if you are homebound. Your doctor must order the care and create a treatment plan. Coverage includes physical therapy, occupational therapy, and speech therapy.

Part A does not cover 24-hour care or custodial services like meal preparation, cleaning, or personal care unless you also need skilled nursing or therapy. Home health care is also covered under Part B in some cases.

What Part A Does Not Cover

Part A does not cover everything. It does not pay for the following services.

• Doctor visits or outpatient care
• Prescription drugs
• Long-term care or custodial care in a nursing home
• Private duty nursing
• Private hospital rooms unless medically necessary
• Personal comfort items like phones or televisions

For these services, you need Medicare Part B and Part D, or a Medicare Advantage plan.

How Much Does Part A Cost?

Monthly Premium

Most people pay no monthly premium for Part A. You qualify for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 40 quarters. This equals about 10 years of work.

If you have fewer than 40 quarters, you may need to pay a premium. In 2026, the premium is $285 per month if you have 30 to 39 quarters of work. If you have fewer than 30 quarters, the premium is $518 per month.

Deductible and Coinsurance

Even if you do not pay a monthly premium, you still have out-of-pocket costs. Part A uses a benefit period system. A benefit period begins when you enter a hospital or skilled nursing facility and ends when you have been out for 60 consecutive days.

For 2026, you pay the following costs per benefit period.

• Hospital deductible: $1,676 for days 1-60
• Daily coinsurance for days 61-90: $419 per day
• Lifetime reserve days (days 91 and beyond): $838 per day for up to 60 days total
• Skilled nursing facility coinsurance: $209.50 per day for days 21-100

There is no copayment for hospice care or most home health care services.

Who Qualifies for Premium-Free Part A?

You qualify for premium-free Part A if you meet one of these conditions.

• You worked and paid Medicare taxes for at least 40 quarters.
• Your spouse worked and paid Medicare taxes for at least 40 quarters.
• You are already receiving Social Security or Railroad Retirement Board benefits.
• You or your spouse worked long enough in a government job where Medicare taxes were paid.

If you do not meet these conditions, you can still buy Part A by paying a monthly premium. You may want to do this if you need hospital coverage and cannot get it another way.

How to Enroll in Medicare Part A

Automatic Enrollment

If you are already receiving Social Security or Railroad Retirement Board benefits, you will be automatically enrolled in Part A and Part B when you turn 65. You will receive your Medicare card in the mail about three months before your birthday.

If you do not want Part B, you can decline it. However, you should keep Part A if it is premium-free because there is no reason to refuse free hospital coverage.

Manual Enrollment

If you are not receiving Social Security benefits, you must sign up for Part A during your Initial Enrollment Period. This period lasts seven months. It begins three months before the month you turn 65, includes your birthday month, and ends three months after.

You can enroll online at the Social Security website, by phone, or at a local Social Security office. If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period from January 1 to March 31 each year. Coverage starts July 1.

Key Takeaways

Medicare Part A covers hospital care, skilled nursing, hospice, and home health services. Most people do not pay a monthly premium if they or their spouse worked for at least 10 years and paid Medicare taxes.

Even with premium-free Part A, you will pay a deductible and coinsurance for hospital stays and skilled nursing care. Part A does not cover doctor visits, outpatient care, or prescription drugs. You need Part B and Part D for full coverage.

If you are already receiving Social Security benefits, you will be automatically enrolled in Part A when you turn 65. If not, you must sign up during your Initial Enrollment Period to avoid delays in coverage.