Medicare Part A (Hospital Insurance)

Medicare Part A is the hospital insurance component of Original Medicare, the federal health insurance program for Americans aged 65 and older and certain younger individuals with disabilities. It covers inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health services.

Part A is one of the foundational pillars of Medicare, established in 1965 as part of the Social Security Act. Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working for at least 10 years (40 quarters).

While Part A provides critical hospital coverage, it does not cover everything. Outpatient services, doctor visits, and prescription drugs require additional Medicare coverage through Parts B and D or a Medicare Advantage plan.

What Part A Covers

• Inpatient hospital stays (semi-private room, meals, nursing services, medications administered during stay)
• Skilled nursing facility (SNF) care for up to 100 days per benefit period following a qualifying 3-day hospital stay
• Hospice care for terminally ill patients, including pain management and comfort care
• Home health care services including intermittent skilled nursing, physical therapy, and medical social services
• Inpatient care in a religious nonmedical health care institution
• Blood transfusions (after the first 3 pints per calendar year)

What Part A Does NOT Cover

• Long-term custodial care in a nursing home
• Outpatient doctor visits and most physician services
• Prescription drugs (covered under Part D)
• Dental, vision, and hearing services
• Private-duty nursing
• Non-medical personal care services

Who Qualifies for Medicare Part A

• Adults aged 65 or older who are U.S. citizens or permanent legal residents for at least 5 continuous years
• Individuals under 65 who have received Social Security Disability Insurance (SSDI) for 24 months
• People of any age with End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant
• People of any age diagnosed with Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig's disease)

Most people qualify for premium-free Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). Those who do not meet the work requirement may still enroll by paying a monthly premium.

2025/2026 Part A Costs

• Premium: $0/month for most people (premium-free if you have 40+ quarters of work). Up to $518/month in 2025 if you have fewer than 30 quarters.
• Hospital Deductible: $1,676 per benefit period in 2025
• Coinsurance Days 1-60: $0 per day after deductible
• Coinsurance Days 61-90: $419 per day in 2025
• Lifetime Reserve Days (91-150): $838 per day in 2025 (60 total lifetime reserve days)
• Skilled Nursing Facility: $0 for days 1-20; $209.50/day for days 21-100 in 2025
• Beyond 150 days: Patient pays all costs

A benefit period begins when you are admitted to a hospital and ends when you have been out of the hospital or SNF for 60 consecutive days. There is no limit on the number of benefit periods.

How to Enroll

Most people are enrolled automatically in Part A when they turn 65 if they are already receiving Social Security benefits. Otherwise, you can enroll during specific periods:

• Initial Enrollment Period (IEP): A 7-month window around your 65th birthday (3 months before, your birthday month, and 3 months after)
• General Enrollment Period (GEP): January 1 through March 31 each year, with coverage beginning July 1
• Special Enrollment Period (SEP): Available if you delayed enrollment because you had employer-based coverage. You can enroll anytime while covered or within 8 months of losing employer coverage.

You can enroll online at ssa.gov, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office.

Pros

• Premium-free for most Americans who have paid Medicare taxes for 10+ years
• Provides essential hospital and inpatient coverage nationwide
• Accepted by nearly all hospitals in the United States
• No prior authorization needed for emergency hospital admissions
• Hospice coverage provides critical end-of-life care support

Cons

• High per-benefit-period deductible ($1,676 in 2025) with no annual out-of-pocket maximum
• Significant coinsurance costs for extended hospital stays beyond 60 days
• Does not cover long-term custodial nursing home care
• Limited skilled nursing facility coverage (100 days max per benefit period)
• No coverage for outpatient services, prescriptions, dental, vision, or hearing