Medicare Part A: Your Questions Answered

For most U.S. citizens aging into Medicare, Part A is a cornerstone of healthcare that provides invaluable assistance with potentially devastating hospital bills.

Most U.S. citizens can first enroll in Part A, commonly referred to as hospital insurance, at age 65. It doesn’t require you to pay a monthly premium as long as you have worked at least 10 years. People with a hospital stay who use Medicare Part A coverage may incur some out-of-pocket expenses, but those costs are a fraction of what they would be without Part A.

In a nutshell, Medicare Part A helps pay for hospital bills that can quickly run into the tens of thousands of dollars.

Healthcare.gov estimates that the average bill for a three-day stay is $30,000. For a Medicare-approved three-day stay in the hospital in 2024 — and for up to 60 days — a person with Medicare Part A would be responsible for the deductible of $1,632.

What Is Not Covered by Medicare Part A?

In the example above, keep in mind that Part A covers only the hospital bill itself. This means Part A may not cover some of the services or care you receive during your stay. However, Part B or Part D may cover some or all of these services and costs.

Medicare Part A is only a portion of your Medicare options, but it’s the one that nearly everyone should add at age 65. Here’s a snapshot of Medicare Part A coverage.

Do I Need Medicare Part A?

As long as you qualify for Medicare Part A without a monthly premium, there’s no reason to pass on the protection it provides — and 99 of out 100 people age 65 and older qualify for Part A without a monthly premium.

Even if you still have health insurance from an employer when you turn 65, Part A could help ease your out-of-pocket burden as a secondary payer.

Medicare Part A is not “free” because you are always responsible for at least the benefit period deductible if you make a claim, but carrying the protection provided by Part A comes without the expense of a monthly premium for most Americans.

How do you know if you will have to pay a premium for Medicare Part A?

• If you have paid Medicare taxes through an employer for 40 quarters (10 years) over your lifetime, you can enroll at age 65 and don’t have to pay a Medicare Part A premium.
• If you have paid Medicare taxes for 30-39 quarters, you have to pay a Part A premium of $278 a month in 2024. If you have paid Medicare taxes for less than 30 months, you have to pay a Part A premium of $505 a month in 2024.

(Note: If you enroll and have to pay a Part A premium, you are required to enroll in Part B and pay at least the standard monthly premium of $174.70 in 2024.)

Regardless of whether you pay a premium for Part A,  you are responsible for certain costs associated with an inpatient hospital stay.

While most forms of insurance have an annual deductible, Medicare Part A is unique because you must meet a deductible every “benefit period.” So if you have two hospital stays within the same year, you have to pay the Part A deductible for each visit. However, you get the same break on coinsurance for each hospital stay.

• Let’s say you are admitted as an inpatient to the hospital in February in 2024 and spend 46 days there. For the hospital portion of your medical bills, you will be responsible for the benefit period deductible of $1,632.
• Let’s say you are admitted again in August of 2024 and again stay 46 days. For the hospital portion of your medical bills, you will be responsible for the benefit period deductible of $1,632. But even though your total days in the hospital for the year is now 92, you still don’t have to pay any daily coinsurance because each benefit period starts over at Day 1.

What Are Lifetime Reserve Days?

If any individual hospital stay lasts beyond Day 90, you can use some of your lifetime reserve days, although doing so triggers a significantly more expensive coinsurance responsibility. Medicare Part A allows you 60 of these days over your lifetime, and they can be used as a part of any number of hospital stays that surpass 90 days throughout your lifetime.

Once your lifetime reserve days are exhausted, Medicare Part A offers no further coverage.

Leading up to your 65th birthday and anytime afterward, you can enroll in Medicare Part A if you aren’t required to pay a monthly premium. People who have to pay a Part A premium don’t have the same flexibility because they also are required to enroll in Medicare Part B, which is limited to specific enrollment periods.

Unless you qualify for Part A before age 65, your first window for enrolling is the Initial Enrollment Period, which includes the three months before your 65th birthday, birthday month, and three months after your birthday. Whenever you sign up, Medicare Part A provides retroactive coverage for up to six months, so your Part A coverage actually will “begin” the first day of the month you turn 65 as long as you enroll less than six months before your birthday month.

If, however, you wait to enroll in Part A until after your Initial Enrollment Period ends, you won’t be able to enroll in Part B (medical insurance) unless you happen to be in a different enrollment period. For people who want to or are required to add Part B in conjunction with Part A, enrollment after the Initial Enrollment Period is limited to:

• The General Enrollment Period, which runs from January 1 to March 31 each year.
• A Special Enrollment Period, which is granted under circumstances like the loss of employer health insurance.

Also of note: You may automatically enroll in Part A and Part B leading up to your 65th birthday if you are already receiving Social Security payments at least four months before your birthday. You can opt out of one or both.

Medicare Part A and Part B collectively make up Original Medicare and feature completely different coverages and costs. Often, people age 65 and older enroll in both to provide coverage for many healthcare needs.

While Part A provides hospital insurance, Part B provides medical insurance. Part B covers preventive screenings and medically necessary treatments, services and equipment.

The coverage provided by Part A and Part B doesn’t overlap per se, but one or the other may cover the same thing depending on the circumstances. For example, Part A covers surgery as a part of an inpatient hospital stay; the same surgery performed in an outpatient setting is covered by Part B.

Do the Part A and Part B Premiums Cost the Same?

While Part A doesn’t require a monthly premium for most people, Part B has a standard monthly premium. Medicare Part B was $174.70 a month in 2024 for individuals making $103,000 or less.

And while Part A has a benefit period deductible and coinsurance for hospital stays over 60 days, Part B has an annual deductible ($240 in 2024). After you pay the deductible, Part B pays 80% of the bill, and you pay 20% coinsurance.

Suppose you have Part A and Part B and decide to switch to a Medicare Advantage plan provided by a private insurance company. In that case, you will get at least the same coverage provided by Parts A and B but possibly at a different cost. Some Medicare Advantage plans help cover your monthly premiums.