Part A has no monthly premium for most people, but you will pay when you use it

If you or your spouse paid Medicare taxes while working for at least 10 years, you do not pay a monthly premium for Medicare Part A (hospital insurance). This is true whether you are 65 or older, or younger and on Medicare because of disability or end-stage renal disease.

However, Part A is not free to use. When you go to the hospital, you pay an inpatient deductible — a set amount you cover before Medicare starts paying. In 2024, that deductible is $1,676 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 pay the deductible again.

After you meet the deductible, Medicare covers all hospital costs for days 1 through 60. Days 61 through 90 require a daily coinsurance amount (in 2024, $419 per day). Beyond 90 days, costs rise sharply. Most people have a "lifetime reserve" of 60 additional days, and Medicare covers all but $838 per day of those. Once your lifetime reserve is used, you pay all costs.

Key Takeaways

  • You pay no monthly premium for Part A if you worked and paid Medicare taxes for at least 10 years, or if your spouse did.
  • You pay a deductible ($1,676 in 2024) each time you enter the hospital, before Medicare covers anything.
  • After the deductible, Medicare covers all inpatient hospital costs for the first 60 days of each hospital stay.
  • Skilled nursing facility care, hospice, and home health services covered by Part A have different cost structures and may have no coinsurance.
  • If you did not work long enough to may have access to for premium-free Part A, you can buy it, but the monthly cost varies based on your work history.

Who pays a monthly premium for Part A

If you did not work long enough to may have access to for free Part A, you can still buy it. The monthly premium depends on how many years you or your spouse paid Medicare taxes. In 2024, the premium ranges from about $278 to $505 per month, depending on your work history. Social Security will tell you whether you may have access to for premium-free Part A when you explore for Medicare.

Some people become may be able to access for Part A later in life. If you reach 65 and do not yet may have access to, you can enroll and pay the premium. Once you have paid premiums for 30 quarters (roughly 7.5 years), you become may be able to access for premium-free Part A going forward.

Skilled nursing facility costs under Part A

If you need care in a skilled nursing facility (a nursing home providing medical care, not just room and board), Part A covers it — but only after a hospital stay of at least three days. Medicare covers all costs for days 1 through 20. Days 21 through 100 require a daily coinsurance amount (in 2024, $209.50 per day). After day 100, you pay all costs.

This is different from a regular nursing home or assisted living facility, which Part A does not cover at all. Ask your hospital discharge planner whether the facility you are considering is a skilled nursing facility covered by Medicare, because the name alone does not always make this clear.

Home health and hospice services

Part A covers home health services (nursing, physical therapy, medical equipment) with no coinsurance or deductible, as long as your doctor says you are homebound and need skilled care. You pay nothing for the visits themselves, though you may pay 20% of the cost of medical equipment like oxygen or a walker.

Hospice care — comfort-focused care for people with a terminal illness — is also covered by Part A with no deductible or coinsurance. You pay a small copay (up to $5) for medications and medical supplies, but nothing for the hospice services themselves. Once you choose hospice, you are giving up curative treatment covered by Medicare, so this is a decision to discuss carefully with your doctor and family.

What happens if you do not have Part A

If you turn 65 and do not enroll in Part A when you first become may be able to access, you may face a late enrollment penalty. The penalty is 10% of the monthly premium for each full year you could have had Part A but did not enroll. This penalty is permanent — it stays with you for life, even after you finally sign up.

There are exceptions: if you were still working and covered by your employer's health plan, or if you were covered by your spouse's employer plan, you may not owe a penalty. You have eight months after leaving that job or losing that coverage to enroll in Part A without penalty. If you think you may may have access to for an exception, contact Social Security before enrolling to ask.

Comparing Part A costs to other coverage

Part A is one piece of Medicare. Many people also buy Part B (doctor visits and outpatient care), which does have a monthly premium. Some buy a Medigap policy to cover the deductibles and coinsurance Part A leaves you responsible for. Others choose Medicare Advantage (Part C), which combines Part A and Part B through a private insurer and has different cost structures — usually lower premiums but higher out-of-pocket costs when you use care.

The choice depends on how much hospital care you expect to need, your budget for premiums, and whether you want to limit your out-of-pocket costs. A Medigap plan, for example, might cost $100 to $300 per month but would cover your Part A deductible and coinsurance. A Medicare Advantage plan might have a $0 premium but require you to pay $50 or more per hospital visit.

Keeping track of your Part A costs

Each time you use Part A services, you will receive a bill. Hospital bills are complex and often contain errors. After you are discharged, ask for an itemized bill and compare it to your Medicare Summary Notice, which you receive by mail or through your online Medicare account. The notice shows what Medicare paid and what you owe.

If you see a charge you do not recognize or believe is wrong, contact the hospital's billing department first. If you cannot resolve it, you can file an appeal with Medicare. Keep all bills and notices for your records, and do not ignore them — unpaid hospital bills can affect your credit and lead to collection action.

Frequently Asked Questions

Do I have to pay the Part A deductible every time I go to the hospital?

Only if a new benefit period has started. A benefit period ends 60 days after you leave the hospital. If you are readmitted within 60 days, you do not pay a new deductible. If you stay out for more than 60 days and then return, a new benefit period begins and you pay the deductible again.

What if I cannot afford the Part A deductible or coinsurance?

Talk to the hospital's financial counselor before or right after admission. Many hospitals have charity care programs or can work out a payment plan. You may also may have access to for Medicaid, which can help pay Medicare costs if your income is low enough. Contact your state Medicaid office to learn what the income limits are in your state.

Does Part A cover prescription drugs?

No. Part A covers hospital and skilled nursing care, but not medications you take at home. For prescription drug coverage, you need Part D (a separate plan you buy) or a Medicare Advantage plan that includes drug coverage. Part D has its own monthly premium and cost-sharing.

Can I drop Part A if I do not think I will use it?

You can decline Part A when you first become may be able to access, but if you change your mind later, you may face a late enrollment penalty. The only exception is if you have other health coverage (like an employer plan) that is as good as Medicare. If you are unsure, it is usually safer to enroll, since the penalty can be permanent.

Will my Part A costs go up every year?

Yes. Medicare adjusts the deductible and coinsurance amounts each year based on inflation and changes in hospital costs. The amounts for 2024 are higher than 2023, and they will likely be higher again in 2025. Social Security announces the new amounts in the fall, before they take effect in January.