Medicare Part A: Cost, Coverage, and Eligibility

Medicare Part A covers hospital stays, skilled nursing, hospice, and limited home healthcare. It’s available to seniors 65 and older and younger people with qualifying disabilities.

Premiums are typically free if you or your spouse paid Medicare taxes for at least 10 years (or 40 quarters). However, beneficiaries are required to pay coinsurance and meet a deductible for every hospital stay. Medicare Savings Programs (MSPs) can help you cover insurance costs.

Most retirees automatically enroll in Part A with Social Security benefits, but consider comparing Medicare Part A, B, C, D, and Medigap plans to ensure you’re completely covered. Call (855) 634-0435 now to speak with a licensed insurance agent, or enter your ZIP code.

Medicare Part A Coverage

Medicare Part A benefits cover all inpatient care needs, from hospital stays to nursing care. It will also cover inpatient services if you’re admitted to a psychiatric hospital.

Who is eligible for Medicare? Most seniors are automatically enrolled with their Social Security benefits when they turn 65 and can immediately start using Medicare Part A benefits. Younger individuals with disabilities also qualify for Medicare benefits.

55% of beneficiaries use their Medicare Part A coverage for hospital visits, while 20% use it to help cover costs to stay in a skilled nursing facility. Many also use their Part A coverage to help pay for hospice costs and ensure comfortable end-of-life care.

Inpatient Hospital Stay

Inpatient hospital care is one of the most important parts of Medicare, and Medicare Part A covers up to 90 days in a hospital within a benefit period. The first 60 days require a $0 coinsurance, but you will have to pay $419 for days 61-90. This same coverage applies to inpatient psychiatric hospitals as well.

You are responsible for paying out of pocket for anything beyond 90 days. Medicare Part A does have a 60-day reserve over your lifetime, after paying an $838 coinsurance, but coverage ends after 120 consecutive days. However, benefits restart with each new hospital stay.

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Skilled Nursing Facility

Medicare Part A also covers skilled nursing care at an in-network facility. To qualify, you must have a prior inpatient hospital stay of at least three days and need daily skilled outpatient care that can only be provided in a facility. The first 20 days are covered without coinsurance, but days 21-100 require a $209.50 coinsurance. After 100 days, you’re responsible for all costs unless you have supplemental insurance.

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Hospice Care

Medicare Part A hospice benefits kick in after a terminal diagnosis. Once you qualify, you’re eligible for two 90-day benefit periods followed by unlimited 60-day periods.

You’ll typically pay nothing for hospice services, except a 5% coinsurance for inpatient respite care and up to $5 for each prescription for pain or symptom management. Learn more about Medicare Part D for prescription costs.

Home Health Services

Medicare Part A home health lets you get skilled care at home after a qualifying hospital or nursing facility stay, with no out-of-pocket cost for the service, but there are limitations. Coverage only applies when you’re homebound and meet certain criteria, and is typically ordered by your doctor as part of a formal care plan. Care must be part-time or intermittent and all delivered through a Medicare-certified home health agency.

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What Medicare Part A Doesn’t Cover

Medicare Part A covers a wide variety of inpatient care services you would need in a hospital or nursing facility, but there is a long list of exclusions that your Original Medicare plan won’t pay for.

Medicare Part A Exclusions

You may only need one type of policy to fill in a specific gap in your Part A coverage. For instance, Medicare Part D specifically covers prescription drugs and can be used with Part A only, Original Medicare, or your existing health coverage.

You are responsible for finding the appropriate health insurance to cover the gaps. Some Medicare Advantage plans may include additional benefits that pay for these coverages, but many people turn to Medicare Supplemental Insurance (Medigap) to fill in the holes in their Part A policy.

Medicare Part A won’t cover everything — it’s called hospital insurance because it only covers inpatient care, and there are limits to this coverage.

Medicare Part A Pros & Cons

It covers hospital stays, but only 60 days are free, and skilled nursing care coverage is limited to 100 days until coinsurance payments are required. Other services are limited to medical necessity, typically post-op nursing care and rehabilitation.

Medicare recipients are also limited to network-only providers, which means you could lose access to your family practitioner or preferred specialists.

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Medicare Part A Cost

Most seniors pay nothing for Medicare Part A coverage. Premiums are $0 per month, and cosinsurance costs only kick in after a set number of days.

Medicare Part A: Copay, Coinsurance, & Premium Breakdown

If you don’t meet the minimum work requirements, you could pay up to $505 a month for coverage. You’re also responsible for paying the Medicare Part A deductible, which must be met at every hospital visit.

Medicare Copay, Coinsurance, & Premium Breakdown

There are many ways to finance what health insurance won’t cover, so it’s recommended that you still sign up for Part A as soon as you’re eligible. It’s the most affordable option for seniors, especially those with pre-existing conditions.

Medicare Part A vs. Medicare Part B

What is the difference between Plan A and B? Medicare Part A covers inpatient care, like hospitals, while Medicare Part B covers outpatient care, including doctor visits and medical supplies. Part A and Part B Medicare work together as the two halves of Original Medicare, but cover different parts. How much does Medicare Part B cost? Part B premiums are $185 per month.

What does Medicare Part B not cover? It won’t pay for the hospital coverage Part A covers, and it doesn’t cover prescription drugs or dental care. In that case, do you really need Medicare Part B? It is recommended to get both, as each plan can sometimes overlap. For example, while Part A covers hospital stays, Part B covers the ambulance you might take to get there.

Because neither Part A nor Part B covers everything, many people turn to Medicare Advantage plans (Medicare Part C), which package these benefits together and help fill in coverage gaps. If you have questions about Medicare Part A, B, and C, call (855) 634-0435 now for help.

Medicare Part A Eligibility

To qualify for Medicare Part A, most people become eligible at age 65. Most retirees are automatically enrolled if they’re already receiving Social Security benefits, but others may need to apply through the Social Security Administration to activate their coverage.

People under 65 may also qualify if they’ve received Social Security Disability Insurance (SSDI) for 24 months, or if they have End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS).

Part A is premium-free if you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years). If you don’t meet the work requirement, you can still buy Part A by paying a monthly premium, which is based on how long you or your spouse worked.

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Medicare Part A Enrollment

Most seniors are automatically enrolled in Medicare Part A when they turn 65 and start receiving Social Security benefits. However, eligibility officially starts three months before your 65th birthday, so you can sign up for Medicare early during the Initial Enrollment Period (IEP).

Medicare Enrollment Periods: Dates & Options

Once you turn 65 and meet Medicare Part A eligibility requirements, take the following steps to get the coverage you need:

1. Gather Required Documents: Have your Social Security number, birth certificate, proof of legal residency, and any current health insurance information.
2. Apply Online: Enroll online with the Social Security Administration (SSA) or by calling (855) 634-0435 to speak with a licensed insurance agent.
3. Choose Your Coverage: Decide whether to enroll in Part A only or in both Part A and Part B.
4. Receive Your Medicare Card: After processing (usually within 30 days), your card will arrive in the mail showing your Part A start date.

If you wait to get coverage, then sign up during a General Enrollment Period (GEP), but you could pay a penalty if you wait too long. Special Medicare Part A enrollment periods are reserved for those who receive disability benefits or a terminal diagnosis.

Everything You Need to Know About Medicare Part A

If you’re wondering how Medicare works, Medicare Part A is your hospital insurance, covering inpatient stays, skilled nursing care, hospice, and limited home healthcare. While it’s premium-free for most who paid Medicare taxes during their working years, it does have limits, such as caps on covered days and in-network doctors and facilities (Learn More: Best Endocrinologists That Accept Medicare).

Medicare Part A Overview

If you don’t meet the work requirement, you may still qualify by paying a monthly premium, but Medicare Part A costs can reach $505 a month. Speaking with a licensed insurance agent can help you compare all your options and find the right balance of cost and coverage. Call (855) 634-0435 to get started now.