Most people do not pay a monthly premium for Part A, but you may owe costs when you use hospital services

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. If you or your spouse paid Medicare taxes for at least 10 years while working, you receive Part A with no monthly premium when you turn 65. However, "no premium" does not mean "no cost"—you pay out-of-pocket when you actually use hospital services, and those costs depend on how long you stay and what type of care you receive.

If you did not work long enough to may have access to for premium-free Part A, you can still enroll and pay a monthly premium. The premium amount varies based on how many quarters of Medicare tax coverage you have. The Social Security Administration determines your specific premium when you first enroll.

Key Takeaways

  • If you paid Medicare taxes for 10 years or more, Part A has no monthly premium; if you did not, you pay a monthly premium that varies by your work history.
  • You pay a deductible for each hospital stay (the amount changes yearly), and then Medicare covers most costs for the first 60 days.
  • Days 61 through 90 of a hospital stay require a daily coinsurance amount you pay out of pocket; days beyond 90 use "lifetime reserve days" with a higher daily cost.
  • Skilled nursing facility care requires a 3-day hospital stay first, and you pay coinsurance starting on day 21.
  • Home health services and hospice typically have no coinsurance or deductible if the care meets Medicare's requirements.

The deductible you pay for each hospital stay

When you are admitted to a hospital as an inpatient, you pay a deductible before Medicare begins to pay. This deductible resets each time you start a new hospital stay, even if your previous stay ended just days before. The deductible amount changes every year; you can find the current year's amount on Medicare.gov or by calling 1-800-MEDICARE.

After you pay the deductible, Medicare covers the full cost of your hospital room, meals, medications, and most services for days 1 through 60 of your stay. You pay nothing additional during this period as long as the hospital is in the Medicare network and you are admitted as an inpatient (not observation status, which is different and may be covered under Part B instead).

Coinsurance for longer hospital stays

If your hospital stay extends beyond 60 days, you begin to pay a daily coinsurance amount for each day you remain in the hospital. This coinsurance covers days 61 through 90. The daily amount is set by Medicare and changes yearly. You are responsible for this coinsurance; Medicare covers the rest of the hospital bill.

If you stay in the hospital longer than 90 days, Medicare provides lifetime reserve days—a total of 60 additional days you can use over your lifetime. These reserve days have a higher daily coinsurance than days 61–90. Once you use all 60 lifetime reserve days, you pay the full cost of any additional hospital days yourself. Lifetime reserve days do not renew each year; they are a one-time pool across your entire life.

Skilled nursing facility costs after a hospital stay

If you move from a hospital to a skilled nursing facility (a facility that provides medical care beyond what a regular nursing home offers), Part A may cover some of the cost. However, you must have been admitted to the hospital as an inpatient for at least 3 consecutive days before the transfer, and you must enter the skilled nursing facility within 30 days of leaving the hospital.

Medicare covers the full cost of skilled nursing facility care for the first 20 days. Starting on day 21, you pay a daily coinsurance amount for days 21 through 100. After day 100 of a single stay, you pay the full cost yourself. Like the hospital deductible, this benefit resets if you have a break of 60 days or more between skilled nursing facility stays.

Home health and hospice coverage

Part A covers home health services—such as nursing care, physical therapy, or occupational therapy delivered at your home—when a doctor determines you are homebound and need skilled care. You pay no deductible or coinsurance for home health services covered by Part A, though you may owe 20% coinsurance if you use durable medical equipment like a wheelchair or oxygen.

Hospice care for terminally ill patients is also covered by Part A with no deductible. You may pay a small coinsurance for medications and respite care (temporary relief for your caregiver), but the amounts are capped and far lower than the costs of hospital or facility care. Hospice is covered regardless of how long you receive it, as long as your doctor certifies that you have a life expectancy of 6 months or less.

If you did not pay enough Medicare taxes to may have access to for premium-free Part A

Some people reach 65 without 10 years of Medicare tax contributions. If this applies to you, you can still enroll in Part A by paying a monthly premium. The premium amount depends on how many quarters of coverage you have: those with 30 to 39 quarters pay one rate, and those with fewer than 30 quarters pay a higher rate. Both rates change yearly.

Once you pay the premium and enroll, the deductibles and coinsurance amounts are the same as for people with premium-free Part A. The only difference is the monthly cost you pay upfront. You can find your specific premium by contacting Social Security or Medicare directly.

How to find your exact costs before a hospital stay

The deductible, coinsurance, and daily amounts for Part A change every January. Before you enter a hospital or facility, you can call 1-800-MEDICARE to ask what your out-of-pocket costs will be for the type of care you expect to receive. Have your Medicare card ready and describe your situation—for example, "I am having a 2-day hospital stay" or "I am moving to a skilled nursing facility for 30 days."

You can also visit Medicare.gov and search for the current year's Part A costs. The site lists the deductible, daily coinsurance amounts, and lifetime reserve day costs in a clear format. Knowing these numbers ahead of time helps you plan and understand what to expect on your hospital bill.

Frequently Asked Questions

Do I have to pay for Part A if I worked long enough?

No. If you or your spouse paid Medicare taxes for at least 10 years, Part A is free when you turn 65. You pay no monthly premium. You only pay when you use hospital or facility services, and those costs are the deductible and coinsurance described above.

What is the difference between the hospital deductible and coinsurance?

The deductible is a single amount you pay once per hospital stay before Medicare starts paying. Coinsurance is a daily amount you pay for each day you stay in the hospital or facility after a certain point. For example, you pay the deductible upfront, then nothing for days 1–60, then daily coinsurance for days 61–90.

Can I use my lifetime reserve days more than once?

No. You have 60 lifetime reserve days total across your entire life. Once you use them, they are gone. They do not renew each year. If you use all 60 and stay in the hospital longer, you pay the full cost yourself.

Do I pay anything for home health care under Part A?

Usually no. Home health services covered by Part A have no deductible or coinsurance. You may owe 20% coinsurance only if you use durable medical equipment. The services must be ordered by a doctor and delivered by a Medicare-approved home health agency.

What happens if I stay in a skilled nursing facility for more than 100 days?

After day 100 of a single skilled nursing facility stay, Medicare stops paying and you pay the full daily cost yourself. This resets if you leave the facility for 60 days or more and then return.