Medicare Part A
Key Takeaways
- Medicare Part AMedicare Part A is hospital insurance, which covers the care you receive while admitted to a hospital, skilled nursing facility, or other inpatient facility. Medicare Part A is part of Original Medicare. provides coverage to U.S. adults age 65 and older for inpatient stays in hospitals and similar medical facilities.
- Part A covers surgeries, lab tests, and drugs during an inpatient stay.
- The vast majority of those eligible for Medicare Part A don’t have to pay a monthly premium, but they are responsible for a benefit period deductible for every qualifying hospital stay as well as daily coinsurance after 60 days.
- Medicare generally defines a hospital stay that qualifies for Part A coverage as “two or more nights of medically necessary hospital care.”
What Is Medicare Part A?
Medicare Part A is hospital insurance, helping to manage the costs of inpatient care. Part A works alongside Medicare Part B, which covers outpatient and medical services. Together, Part A and Part B form Original Medicare, the U.S. public health insurance program for older adults and people with certain disabilities.
Medicare Advantage plans (Part C) plans from private insurance carriers are required to offer at least the same level of coverage as Original Medicare, including Part A hospital coverage.
While U.S citizens and permanent residents who have paid Medicare taxes through work for at least 10 years (and their spouses) don’t have to pay a monthly premium, it’s important to understand the Medicare Part A cost structure. Part A doesn’t pay for every expense related to inpatient care, so you should know what’s covered, what’s not, and what defines a qualifying hospital stay.
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What Does Medicare Part A Cover?
Medicare Part A covers many of the expenses you may incur during a hospital stay, and it also covers inpatient services in semi-private rooms at similar facilities. For example, Part A covers short-term care in a skilled nursing facility or nursing home if you’re receiving doctor-approved treatment for a medical condition stemming from an inpatient hospital stay. Hospice care is also covered if you are terminally ill and accept palliative care for comfort instead of treatment for your illness.
Here’s a look at what Part A covers and corresponding costs:
- Inpatient hospital care: After you meet your deductible, Part A covers 100% for days 1-60. The deductible for an inpatient hospital stay in 2025 is $1,676. For a stay longer than 60 days, you will pay coinsurance.
- Skilled nursing facility stay: Part A covers 100% for days 1-20.
- Home health care: Part A covers 100% for eligible services. You pay 20% of the Medicare-approved amount for durable medical equipment.
- Hospice care: Part A covers 100%. You may pay up to $5 per prescription and 5% for inpatient respite care.
Excluded From Part A Coverage
Even if Medicare Part A covers most of the costs for an inpatient stay, your coverage won’t include:
- A private room (unless medically necessary)
- Private-duty nursing
- Television and phone in your room (if there’s a separate charge for these items)
- Personal care items (like razors or slipper socks)
You are admitted when a doctor formally orders you to be treated as an inpatient after determining that your condition requires hospital care. It’s important to note that being in a hospital bed or receiving care in the emergency room or observation unit does not necessarily mean you have been admitted. You must receive an official inpatient designation to qualify for a Medicare Part A-covered stay.
Do All Hospitals Accept Medicare Part A?
Nearly all U.S. hospitals accept Medicare Part A. According to the American Hospital Association, 96% of hospitals receive payment either from Medicare or from Medicaid, the public health insurance program for U.S. adults with limited incomes, for at least half of inpatient days.
Notable exceptions include Veterans Affairs (VA) hospitals, which provide care to U.S. military veterans who qualify for VA benefits. These hospitals don’t bill Medicare.
Medicare Advantage and Part A
Every Medicare Advantage plan offers, at minimum, the same Part A and B coverage as Original Medicare. Often, plans include a variety of extra benefits.
Medicare Advantage plans protect you with an annual out-of-pocket maximum, a dollar amount specific to your plan that limits how much you will have to pay out of your pocket for covered care in a plan year.
However, while Medicare Part A is accepted at hospitals across the country, Medicare Advantage plans are not. Plans vary based on where you live, and each plan has a provider network. To make the fullest use of your benefits, you generally must go to in-network hospitals, doctors, and pharmacies.
Does Medicare Part A Cover It?
Inpatient care in a hospital
- Yes, Part A covers
Skilled nursing facility care
- Yes, Part A covers
Nursing home care (not custodial or long-term)
- Yes, Part A covers
Hospice care
- Yes, Part A covers
Home health care
- Yes, Part A covers
Long-term care
- No, Part A does not cover
Medically necessary inpatient surgery
- Yes, Part A covers
Cosmetic surgery
- No, Part A does not cover
Inpatient lab tests
- Yes, Part A covers
Emergency room lab tests
- No, but Part B covers
Inpatient vs. Outpatient Care
The key difference between inpatient and outpatient care is whether you are formally admitted to the hospital. You aren’t considered an inpatient until a doctor’s order formally admits you, even if you stay the night. You will be admitted if a healthcare provider determines that you need to stay through two midnights.
If your stay doesn’t meet the requirements of an inpatient stay, you usually need coverage from Medicare Part B. Part B is medical insurance and covers many outpatient expenses.
What to Know About Observation Stays
Observation stays can be confusing because they blur the line between inpatient and outpatient. Even if you spend multiple days receiving care in the hospital, you might still be classified under “observation status.” Why does this matter? Medicare Part A only covers inpatient hospital stays, and observation status falls under Medicare Part B.
Part A Terminology to Understand
To fully understand your Medicare Part A coverage, it helps to know some important terms:
- Benefit period: Measures your use of hospital and skilled nursing care under Part A. A benefit period begins the day you’re admitted and ends after you’ve been out of the facility for 60 days.
- Lifetime reserve day: On top of your covered days for a benefit period, Medicare Part A provides 60 additional hospital days, called lifetime reserve days. You begin to use lifetime reserve days after you’ve been hospitalized for more than 90 days in a single benefit period.
- Medically necessary: Original Medicare only covers services that are medically necessary, which includes tests or treatment needed to diagnose or treat an illness, injury, or condition based on accepted medical standards.
Is Medicare Part A Free at Age 65?
Medicare Part A is not “free” because you are always responsible for at least the benefit period deductible if you make a claim, but there’s no monthly premium for most people.
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 $285 a month in 2025. If you have paid Medicare taxes for less than 30 months, you have to pay a Part A premium of $518 a month in 2025.
(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 $185 in 2025.)
Regardless of whether you pay a premium for Part A, you are responsible for certain costs associated with an inpatient hospital stay.
2025 Costs for a Hospital Stay on Medicare Part A
Inpatient hospital deductible
- $1,676
Daily coinsurance, Days 1-60
- $0
Daily coinsurance, Days 61-90
- $419
Daily coinsurance, up to 60 Lifetime Reserve Days
- $838
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Can I Enroll in Medicare Part A Anytime?
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 triggers when you meet the Part A eligibility criteria. This enrollment period typically starts three full months before your 65th birthday month and ends three months after your birthday month. If you receive Social Security payments for at least four months before your 65th birthday, you may be automatically enrolled in Medicare Part A and Part B. You can opt out of one or both.
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 until after your Initial Enrollment Period ends, you will only be able to enroll in Part B (medical insurance) during another enrollment period:
- 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.
How Part A Works With Part B
Original Medicare’s two parts (A and B) work together to cover your healthcare needs. Medicare Part A will typically cover the costs of hospital stays, surgeries, and care in a skilled nursing facility, while Part B covers doctor visits, durable medical equipment, and preventative services.
For example, imagine you are admitted to the hospital for a medically necessary surgery and require physical therapy after being released. Part A will cover the care and services you received while you were admitted to the hospital. Once you are home, Medicare Part B will step in to help cover the costs of your follow-up doctor visits and physical therapy sessions.
Original Medicare typically does not cover prescription medications you take at home. You will need either a standalone Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug Plan (MAPD).
Putting It All Together
Medicare Part A has you covered for an inpatient hospital stay, skilled nursing care, hospice and some home health care. Knowing what Part A covers – and what it doesn’t – can help you plan for potential healthcare costs. By understanding how Part A works within Original Medicare, you can ensure you have the coverage you need to stay healthy and secure.
FAQ
Can I enroll in Medicare Part A before age 65?
While 65 is the standard eligibility age for first enrolling in Medicare Part A, there are a few situations where you can enroll in Part A before 65.
Once you have collected Social Security disability benefits or Railroad Board benefits for 24 months, you can enroll regardless of age. You also qualify regardless of age if you have end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.
Can I opt out of Medicare Part A?
You are not required to enroll in Medicare Part A. If you start receiving Social Security benefits at least four months before turning 65, you will be automatically enrolled in Part A (and Part B) and will have to actively opt-out if you don’t want one or the other.
As long as you don’t pay a Part A monthly premium, there’s no downside to enrolling in Part A. Even if you pay a monthly premium for Part A, the coverage may work to your benefit in some instances.
Can you lose Part A coverage?
If you must pay a monthly premium for Part A and fail to do so, you may lose Part A coverage. You also, in effect, “lose” the Part A coverage if you use all 60 of your lifetime reserve days.
What if I run out of my Part A lifetime reserve days?
If you are concerned that you might run out of lifetime reserve days, there are a couple of approaches to consider before that happens.
If you have both Part A and Part B, you can add a Medigap supplement plan. All 10 of the standard Medigap plans offered by private insurance companies pay 100% of Part A and extend coverage for up to 365 days after you exhaust your lifetime reserve days.
Alternatively, having Part A and B provides the option to switch to a Medicare Advantage plan. Medicare Advantage plans must provide at least the same coverage as Parts A and B, including hospital coverage through your lifetime reserve days.
Medicare Advantage plans must include an annual out-of-pocket maximum. So the concept of lifetime reserve days might not matter because your hospital expenses should be 100 percent covered once you reach your out-of-pocket maximum.
A GoHealth licensed insurance agent can help identify a Medicare Advantage plan that fits your needs.
Sources
- Inpatient hospital care. Medicare.gov.
- Skilled nursing facility (SNF) care. Medicare.gov.
- Are You a Hospital Inpatient or Outpatient? Medicare.gov.
- ]Medicare costs at a glance. Medicare.gov.
- Fact Sheet: Majority of Hospital Payments Dependent on Medicare or Medicaid. American Hospital Association.