Most people do not pay a monthly premium for Medicare Part A
If you or your spouse paid Medicare taxes while working for at least 10 years, you will not owe a monthly premium for Part A hospital coverage. You may still owe other costs — a deductible when you are admitted to the hospital, coinsurance for longer stays, and copayments for skilled nursing care. But the monthly premium itself is zero.
If you did not work long enough to may have access to for premium-free Part A, you can buy it. The monthly cost varies depending on how many years you or your spouse paid Medicare taxes. In 2024, the premium ranges from about $278 to $505 per month, but this amount changes each year. You will need to contact Social Security or Medicare directly to find out your exact premium, since it depends on your individual work history.
Part A covers hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. It does not cover outpatient doctor visits or prescription drugs — that is what Part B and Part D are for.
Key Takeaways
- You pay no monthly premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years.
- If you do not meet the work requirement, you can buy Part A for a monthly premium that ranges based on your work history.
- Even with premium-free Part A, you will owe a hospital deductible ($1,632 in 2024) when you are admitted, plus coinsurance for stays longer than 60 days.
- Skilled nursing facility care requires a copayment after day 20, and you pay all costs after day 100.
- Your actual out-of-pocket costs depend on how much hospital and nursing care you use, not on whether you pay a monthly premium.
The hospital deductible and coinsurance you will owe
The monthly premium is only one cost. When you are admitted to a hospital, you owe a deductible before Medicare starts to pay. In 2024, that deductible is $1,632 per benefit period. A benefit period starts when you enter the hospital and ends 60 days after you leave without being readmitted. If you go back to the hospital more than 60 days later, a new benefit period begins and you owe the deductible again.
After you pay the deductible, Medicare covers all costs for days 1 through 60 of your hospital stay. On days 61 through 90, you owe a coinsurance amount — in 2024, that is $408 per day. If you stay longer than 90 days, you can use "lifetime reserve days," but you will owe $816 per day for those days. You have only 60 lifetime reserve days total across your entire life, so they are meant for emergencies.
These amounts change every year. Medicare announces the new deductibles and coinsurance amounts in the fall for the following year. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE.
Skilled nursing facility costs after a hospital stay
If you need skilled nursing care after leaving the hospital — such as physical therapy or wound care — Part A covers a skilled nursing facility stay. You must have been admitted to a hospital for at least three days before the nursing facility stay counts as covered.
For days 1 through 20 of a skilled nursing facility stay, Medicare covers all costs. Starting on day 21, you owe a coinsurance amount per day. In 2024, that coinsurance is $204 per day. After day 100, Medicare stops paying and you owe all costs yourself. Like the hospital deductible, these amounts change yearly.
This is different from custodial care — help with bathing, dressing, or eating — which Part A does not cover. A doctor must determine that you need skilled care, not just information with daily living.
Home health services and hospice care
Part A covers home health services when a doctor says you are homebound and need skilled care — such as nursing visits, physical therapy, or occupational therapy. You pay nothing for home health services covered by Part A, as long as you use a Medicare-approved agency. You do not owe a copayment or coinsurance.
Hospice care for a terminal illness is also covered by Part A with no monthly premium. You may owe a small copayment for prescription drugs and respite care (a short inpatient stay to give your caregiver a break), but the hospice services themselves are covered.
What happens if you delay signing up for Part A
If you are not yet 65 and not yet on Social Security, you can sign up for Part A during the three months before your 65th birthday, the month you turn 65, or the three months after. That is your Initial Enrollment Period. If you miss this window and do not have a reason that qualifies as a Special Enrollment Period, you will owe a penalty.
The penalty is a 10 percent increase to your Part A premium for twice the number of years you could have had Part A but did not sign up. For example, if you were may be able to access for two years and did not sign up, you will pay 20 percent more for the rest of your life. This penalty applies only if you have to pay a premium in the first place — if you may have access to for premium-free Part A, there is no penalty.
If you are still working at 65 and have health insurance through your employer, you may be able to delay Part A without penalty. Contact Social Security to ask about your specific situation.
How to find out your exact Part A costs
Your Part A costs depend on your work history, your age, and how much hospital and nursing care you use. To find out whether you may have access to for premium-free Part A, contact Social Security at 1-800-772-1213 or visit ssa.gov. They can tell you how many years of Medicare taxes you or your spouse paid.
If you need to buy Part A because you do not meet the work requirement, Social Security will tell you the monthly premium based on your record. If you are already on Medicare, you can log into your Medicare.gov account to see your current coverage and costs, or call 1-800-MEDICARE to speak with someone.
Your costs will also depend on which hospital and which skilled nursing facility you use, since different facilities may bill differently. When you are admitted, ask the hospital billing department what your out-of-pocket costs will be based on your specific situation.
Questions to ask your doctor or Medicare
Before a hospital or nursing facility stay, ask your doctor whether the care you need will be covered by Part A. Ask specifically whether you will need skilled nursing care or custodial care, since Part A covers only skilled care. If you are unsure whether a facility is Medicare-approved, ask the facility directly or check on Medicare.gov.
If you receive a bill you think is wrong, ask the hospital or facility to explain it. You have the right to see an itemized bill. If you disagree with the charges, you can file an appeal with Medicare. Call 1-800-MEDICARE to learn how to start an appeal.
Frequently Asked Questions
Do I have to pay for Part A if I am still working?
If you are still working and earning income, you still pay Medicare taxes, which count toward your Part A coverage. You can sign up for Part A at 65 even if you are working. If you have health insurance through your employer, you may want to delay Part B, but Part A is usually worth taking at 65 because you have already paid for it through taxes.
What if I worked in another country — does that count toward the 10 years?
Work in most countries does not count toward Medicare. However, some countries have agreements with the United States. Contact Social Security to ask whether your work history in a specific country counts. They can review your record and tell you how many years of U.S. Medicare-covered work you have.
Can I get Part A without Part B?
Yes. You can enroll in Part A alone if you want hospital coverage but not outpatient doctor visits. However, if you delay Part B when you first turn 65, you may owe a penalty when you do sign up later — unless you have a may have access to reason. Talk to Medicare about your situation before you decide.
Do I owe the hospital deductible every time I go to the hospital?
You owe the deductible once per benefit period. A benefit period ends 60 days after you leave the hospital. If you are readmitted within 60 days, you do not owe a new deductible. If you are readmitted more than 60 days later, a new benefit period starts and you owe the deductible again.
What if I cannot afford the deductible or coinsurance?
If your income is low, you may be able to get help paying Part A costs through Medicaid or a Medicare Savings Program. These programs vary by state. Contact your state Medicaid office or call 1-800-MEDICARE to ask whether you may be able to get help with your costs.