What Is Medicare Part A?

Medicare Part A, also known as hospital insurance, is primarily designed to assist beneficiaries with hospital-related expenses during periods of hospitalization and post-hospitalization care in skilled nursing facilities.

Eligibility begins at age 65 or earlier for those with qualifying disabilities, such as Parkinson’s disease or end-stage renal disease (ESRD). If you do not sign up for Medicare benefits during the Initial Enrollment Period (IEP), you might face a penalty that could increase your premiums. Planning your enrollment will help you avoid unnecessary fees and ensure you have coverage when you need it.

Medicare Part A, also called hospital insurance, is one of the four parts of Medicare coverage. It's primarily designed to help you with the costs associated with hospital stays, skilled nursing facility care, hospice and home health services.

Eligibility for Medicare Part A typically starts at 65 but can start earlier under certain conditions, such as having a qualifying disability. You'll automatically be enrolled if you're already receiving Social Security benefits when you turn 65. Otherwise, you can sign up during your Initial Enrollment Period, which begins three months before your 65th birthday and extends three months. Signing up during this period means you'll avoid late enrollment penalties.

For many people, Medicare Part A comes without a monthly premium if you or your spouse have paid Medicare taxes while working for a certain period. This is known as "premium-free Part A." If you don’t qualify for premium-free Part A, you can still enroll by paying a premium.

Medicare Part A covers several key areas of health care, including inpatient hospital care, hospice care and skilled nursing facilities. This coverage ensures that beneficiaries receive the necessary care through a network of approved facilities and providers, emphasizing the importance of recovery and palliation in a medically supervised environment.

Inpatient hospital care is the coverage most commonly associated with Medicare Part A. It covers the care you receive while admitted to a hospital, including:

• Your hospital room (semi-private)
• Meals
• General nursing
• Other hospital services and supplies

Medicare Part A limits inpatient mental health care at a freestanding psychiatric hospital to 190 days over your lifetime. This limitation does not apply if you are admitted to a psychiatric unit within an acute care or critical access hospital.

Note that Medicare Part A does not cover private duty nursing, private rooms (unless medically necessary) or personal items like toothpaste and socks. For each benefit period, you pay a deductible and may have to pay co-insurance if your stay exceeds 60 days.

After a qualifying hospital stay, which typically means you’ve been hospitalized for three consecutive days, Medicare Part A can cover a stay in a skilled nursing facility. However, time spent under observation or as an outpatient before admission does not count toward this requirement.

Skilled nursing facility services covered by Medicare include:

• A semi-private room that you share with other patients
• Meals and dietary counseling to ensure you meet your nutritional needs during recovery
• Skilled nursing care provided by qualified professionals
• Physical, occupational and speech-language therapy as needed to meet your health goals
• Medical social services to help you with social and emotional concerns related to your recovery
• Necessary medications, medical supplies and equipment used within the facility
• Ambulance transportation to the nearest provider of essential services that are not available at the facility if other forms of transportation could endanger your health

Once you are discharged from the hospital, you must enter the skilled nursing facility within 30 days if you need coverage for continued skilled services related to your hospital stay. If you need to re-enter the facility within 30 days of leaving, or if you need to resume skilled care after a break, you do not require another three-day hospital stay to qualify for further benefits.

Part A provides coverage for up to 100 days per benefit period, with no charge for the first 20 days; however, a daily co-insurance fee applies from day 21 to day 100.

To qualify for hospice care under Medicare Part A, you must be certified as terminally ill with a life expectancy of six months or less by both your regular doctor and a hospice doctor. You must agree to receive palliative care instead of treatments aimed at curing your illness and sign a statement choosing hospice care over other Medicare-covered treatments for your terminal condition.

Hospice care can be provided at home or in a facility such as a nursing home and may include the following services:

• Medical care and nursing services to manage symptoms and provide pain relief
• Essential durable medical equipment and necessary medical supplies
• Assistance with household tasks and nutritional advice through an aide, homemaker services and dietary counseling
• Rehabilitative services, such as physical, occupational and speech-language therapy, tailored to your health needs
• Comprehensive social services and support for spiritual and grief counseling for patients and their families
• Short-term inpatient and respite care in Medicare-approved facilities, offering relief to regular caregivers

Note that room and board at a facility are not covered unless you require short-term inpatient or respite care arranged by your hospice team. Also, a hospice doctor must recertify your terminal illness to continue hospice care beyond six months.

Medicare Part A may cover home health services if you meet specific conditions. You must be determined to be "homebound," meaning that leaving your home due to illness or injury is challenging, and your condition makes it inadvisable or requires a considerable and taxing effort.

To qualify for these services, a doctor or other health care provider must see you face-to-face and certify that you need home health services. These include the following:

• Necessary skilled nursing care on a part-time or intermittent basis
• Rehabilitation services such as physical therapy, occupational therapy and speech-language pathology tailored to individual health requirements
• Medical social services to address emotional and social issues stemming from an illness
• Home health aide services on a part-time or intermittent basis, available only alongside skilled nursing care
• Prescribed injectable osteoporosis medications for women
• Essential durable medical equipment and medical supplies for home use

Additionally, you can still receive home health benefits if you go out for medical appointments or other reasons, like attending church services or an adult day care center.

You may automatically qualify for and enroll in Medicare Part A when you turn 65 or if you're already receiving benefits from Social Security or the Railroad Retirement Board. If you are not automatically enrolled, you can sign up through the Social Security Administration online, over the phone or in person at a local office.

Typically, individuals who have paid Medicare taxes during their working years are eligible for Medicare Part A without a premium. However, if you or your spouse did not pay Medicare taxes for a long enough period while working, you might need to pay a monthly premium.

Medicare Part A typically doesn't require a monthly premium if your spouse or you have contributed to Medicare taxes for at least 10 years (40 quarters) of your employment. However, if you have paid Medicare taxes for fewer than 10 years, your monthly premium for Part A could range from $278 to $505, depending on how much you contributed to Medicare.

Note that if you fail to sign up for Medicare Part A when you first become eligible, typically at age 65, you might incur a late enrollment penalty. This penalty increases your Part A premium by 10% if you need to purchase Part A. The penalty lasts twice as long as you could have had Part A but didn’t register.

We break down Medicare Part A costs for 2024 in the table below:

You'll be automatically enrolled in Medicare Part A if you're already receiving Social Security benefits when you turn 65. If not, you can sign up during your Initial Enrollment Period (IEP). This period starts three months before your 65th birthday and ends three months after your birthday month. For instance, if your birthday is in June, your IEP would run from March to September.

Key considerations for signing up for Medicare Part A include: