Medicare Part A(Hospital Insurance)
Healthpilot is your go-to resource for all things Medicare-related, including information about Medicare Part A, also known as Hospital Insurance. Keep reading to learn more about Medicare Part A, including what it covers, who is eligible, how much it costs, and more.
What is Medicare Part A?
Medicare Part A (also known as Hospital Insurance) is the component of Medicare that covers costs for inpatient services. There are four main parts of Medicare (Parts A, B, C, and D).
What does Medicare Part A cover?
As stated above, Medicare Part A covers inpatient medical services. This includes:
Hospital Stays: This includes semi-private rooms, meals, nursing care, and the medications that you require during your inpatient hospital stay.
Home Health Services: Medicare Part A covers part-time skilled nursing, physical therapy, and health aide services at home; these must be prescribed by a doctor within the Medicare network.
Skilled Nursing: Following a qualifying hospital stay, short-term care in a skilled nursing facility (including rehabilitation and therapy) is also covered under Part A.
Hospice Care: Refers to the coverage of end-of-life services such as pain relief, medical support, counseling, and family care.
What Does Medicare Part A Not Cover?
While Medicare Part A covers many inpatient services, there are important gaps to know about. Part A does not cover:
Long-Term Custodial Care: Help with daily activities like bathing, dressing, or eating (when it's the only care you need).
Private Rooms: Unless deemed medically necessary, private rooms at hospitals are not covered under Medicare Part A.
Routine Care Services: Such as vision, dental, or hearing.
Prescription Drugs: Any medications you take at home (though these are typically covered under Medicare Part D).
Medicare Part A Eligibility
Any individual who is age 65 or older is eligible for Original Medicare (which includes Medicare Parts A and B). It's also possible to qualify for Original Medicare coverage before you turn 65 if you have:
A disability that allows you to receive Social Security Disability Benefits (SSDI) for 24 months. These types of disabilities typically constitute the medical diagnosis and documentation of:
- Physical or mental conditions,
- That prevent you from doing SGA (substantial gainful activity), and
- Are expected to last more than a year, or result in death.
End-Stage Renal Disease, defined by permanent kidney failure that requires dialysis or a transplant.
Lou Gehrig's Disease, also known as ALS.
Medicare Part A Costs
In terms of Medicare Part A costs, there are a few different things to keep in mind when determining your healthcare spend. The first two things are:
- If you do not qualify for premium-free part A, in order to enroll in Medicare Part A, you must enroll in Medicare Part B. You may also choose to delay coverage if you are still working or covered under your own or spouse's employer-provided insurance, as long as that plan is considered “creditable coverage” and the employer has 20 or more employees.
- If you miss your initial enrollment period for Medicare Parts A (if not qualified for premium free Part A) or B, and don't have “creditable coverage”, penalties may apply. Be sure to know your enrollment periods if you're approaching the age of 65.
Medicare Part A Premiums
For most beneficiaries, Medicare Part A is premium-free under certain conditions:
If you or a spouse has paid towards Medicare taxes for enough time while working (this timeframe is generally around 10 years).
If you qualify for Medicare Part A under a disability, such as through receiving SSDI benefits.
If you don't qualify for premium-free Medicare Part A, you will have to pay either a $285 or a $518 monthly premium, depending on how many quarters of work you have completed during which you have paid towards Medicare taxes. For fewer than 30 quarters of work, the premium will be the higher amount.
Medicare Part A Deductible
The Medicare Part A deductible as of 2025 is $1,676 per benefit period. The benefit period refers to the amount of time during which you are receiving care from a hospital or skilled nursing facility. The benefit period typically begins the day that you are admitted to the inpatient care facility or hospital, and ends after you have stopped receiving care for 60 consecutive days.
Keep in mind that there is no limit to how many benefit periods you can incur per year, so you will pay the deductible more than once if you are readmitted after the original stay's 60-day window has passed.
Medicare Part A Out-of-Pocket Costs
Medicare Part A out-of-pocket costs can be segmented into each type of inpatient service that is covered by Original Medicare:
Medicare Part A Coverage Amounts by Service
| Service | Coverage |
|---|---|
| Inpatient Hospital Stays | Up to 60 days covered once deductible is met. Days 61-90: $419 / day Days 91-150: $838 / day *You are only allotted 60 of these “lifetime reserve days” over your lifetime. |
| Skilled Nursing Facilities | Up to 20 days covered once deductible is met. Days 21-100: $209.50 / day Day 101+: Full cost |
| Home Health Care | Fully covered (if service is deemed medically necessary) 20%of Medicare-approved amount for medical equipment |
| Hospice Care | Fully covered under Medicare Part A $5 copay for pain relief or symptom control care 95% of respite care is covered (Medicare-approved amount) |
Inpatient stays are covered for up to 60 days once the inpatient deductible is paid. From there, the costs increase: $419 / day for Days 61-90 and $838 / day for Days 91-150. After the 150th day, you will be responsible for the entire cost of any following days.
- Note that after any initial 90 days of hospital care within a single benefit period, you are only allotted 60 additional days (lifetime reserve days) of inpatient coverage over your lifetime.
For skilled nursing facilities, the costs follow a similar structure; covered for the first 20 days once the deductible has been met, Days 21-100 are $209.50 per day, and you will pay the full cost for Days 101 and onward.
Certain home health care services are fully covered under Medicare Part A regardless of the length of time (as long as the service is deemed medically necessary) if you need part-time or intermittent skilled services and you are “homebound”. The plan also covers 20% of the Medicare-approved amount for medical equipment should you require a wheelchair, walker, hospital bed, etc.
Hospice care is also fully covered under Medicare Part A. You may also pay a $5 copay for pain relief or symptom control care (such as prescription drugs). 95% of the Medicare-approved amount for respite care is also covered, leaving you to pay 5%.
How to Apply for Medicare Part A
Before you enroll in Medicare Part A, you'll need to know when you can enroll and how you're planning on enrolling.
Note: If you are already receiving Social Security retirement benefits, you will have been automatically enrolled into Medicare Part A once you turn 65.
When to Enroll in Medicare Part A
Beneficiaries who are looking to enroll in Medicare Part A will likely do so during the Initial Enrollment Period (IEP). This period spans seven months: it begins the three months before your 65th birthday month, includes the month of your 65th birthday, and ends three months after your 65th birthday month.
You also have the option to delay enrollment in Medicare Part A without penalty if you are still receiving healthcare benefits from your or spouse's employer. In this case, you will enroll in Medicare Part A during a Special Enrollment Period (SEP); the timing and length of this period can vary, as SEPs are granted on a case-by-case basis.
Keep in mind that you may be automatically enrolled in Medicare Part A if you are receiving Social Security retirement benefits when you turn 65.
You may also be eligible for Medicare Part A before the age of 65 if you have End-Stage Renal Disease (ESRD), Lou Gehrig's disease (ALS), or have received a disability determination from the Social Security Administration.
How to Enroll in Medicare Part A
There are a couple of different ways you could go about applying for Medicare Part A:
Visit the Medicare enrollment page on the Social Security Administration website and navigate down to “Apply Online” under 'Sign Up for Medicare'.
- You can also check the status of your application from the website linked above after you have completed the enrollment process.
Call the Social Security Administration's Medicare hotline at +1 800-772-1213 and specify the plan or plans in which you'd like to enroll.
Make an appointment at your local Social Security office. This is a great option if you need someone who will be able to assist you with the application in person.
If you'd like additional coverage after Medicare Part A enrollment, Healthpilot is here to help. Click below to read our articles on Medicare Parts C and D as well as Medigap enrollment to learn more.
Learn More About Original Medicare
Medicare Part A FAQs
Medicare Part A is Hospital Insurance; it covers inpatient care (hospitalstays, skilled nursing facility care, hospice, and some home health services).Medicare Part B, on the other hand, is Medical Insurance; it covers outpatientand medical services such as doctor visits, preventive care, lab tests,durable medical equipment, and outpatient procedures.
Together, Medicare Part A and Medicare Part B make up Original Medicare. Original Medicare is the simplest form of Medicare.
While Original Medicare (made up of Medicare Part A (Hospital Insurance) and B (Medical Insurance)) provides a solid foundation, there are some gaps you should be aware of. Original Medicare does not cover:
- Prescription drugs (you'll need Part D for that)
- Routine dental, vision, and hearing care
- Long-term custodial care in nursing homes
- Most routine foot care, hearing aids, and eyeglasses
- Services outside the U.S. (with very limited exceptions)
Because these things have the potential to add up quickly depending on your situation, many people look to additional coverage in the form of Medicare Advantage (Part C), Part D drug plans, or Medigap (supplemental insurance) to fill the gaps.
If this sounds like something you need, Healthpilot makes it easy to compare Medicare plans side by side, so you can see exactly what extra coverage might save you money and fit your lifestyle.
Enrolling in Medicare Parts A and B can be done separately or at the same time.
If you already have Medicare Part A and want to add Medicare Part B, you'll need to enroll through Social Security (or the Railroad Retirement Board). You can fill out and submit the application form online, by mail, or in person by making an appointment at your local Social Security office.
If you're signing up for Medicare Part A outside of your Initial Enrollment Period, you can:
- Wait for the General Enrollment Period (which happens annually from January 1st to March 31st). Keep in mind that late penalties could apply, however.
- Request a Special Enrollment Period, such as in the case where you were previously covered by an employer but are no longer receiving benefits.
- If eligible, you can enroll in premium-free Part A at any time after your first eligible (typically at age 65).
Yes, but also no. For most people, Medicare Part A is premium-free when they turn 65; you'll still be responsible for deductibles, coinsurance, and other out-of-pocket costs when you use your benefits.
If you or your spouse worked and paid Medicare taxes for at least 10 years (or 40 quarters), you will be eligible for premium-free Medicare Part A. If you don't meet that requirement, you are still able to enroll in Medicare Part A, but you will have to pay a monthly premium.
Because Medicare Part A is Hospital Insurance, it may cover surgery costs if you're admitted as an inpatient in a hospital. This coverage includes your hospital room, nursing care, medications, and other hospital services tied to your surgery.
However, surgeon's fees and outpatient procedures are typically billed under Medicare Part B (Medical Insurance). For many surgeries, coverage involves both Parts A and B working together, which is why most people opt to enroll in both when they are eligible and ready to do so.
No, Medicare Part A is not mandatory. That being said, most people choose to enroll in Medicare Part A when they turn 65 because it's premium-free for most, and provides essential healthcare coverage during retirement.
If you choose not to sign up for Part A and don't have other health coverage, you will face higher out-of-pocket costs. Delaying enrollment is possible if you are still working or receive retirement benefits through your former employer that provides creditable health insurance coverage, but once that ends, you'll need to sign up quickly in order to avoid gaps.