What Medicare Part A Covers and Who Gets It Automatically

Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. Most people do not have to do anything to get Part A — it comes automatically when you turn 65 if you or your spouse paid Medicare taxes while working.

You become may be able to access for Part A at 65 if you have worked and paid into Social Security for at least 10 years (40 quarters). Your spouse can get Part A on your work record even if they did not work that long. If you are under 65, you may get Part A if you have received Social Security disability benefits for 24 months, have end-stage renal disease, or have ALS (amyotrophic lateral sclerosis).

Part A is free for most people. You do not pay a monthly premium. You pay a deductible when you go to the hospital, and you pay coinsurance for longer stays — the amounts change each year. In 2024, the hospital deductible is $1,676 per benefit period, but this figure changes annually.

Key Takeaways

  • Most people get Part A automatically at 65 without taking any action, as long as they or a spouse paid Medicare taxes for at least 10 years.
  • You should still create a Medicare account and check your enrollment status a few months before you turn 65 to make sure the Social Security Administration has your correct information.
  • If you are still working at 65 and have health insurance through your job, you can delay Part A enrollment without penalty, but you must enroll within eight months of leaving that job.
  • If you did not get Part A automatically, you can enroll during the General Enrollment Period (January 1 to March 31 each year), but you may pay a higher premium.
  • Part A does not cover doctor visits, outpatient care, or prescription drugs — you need Part B and Part D for those, or you need a Medicare Advantage plan.

When Part A Enrollment Happens Automatically

The Social Security Administration enrolls you in Part A automatically three months before the month you turn 65. For example, if your birthday is in June, Social Security enrolls you in March. You do not need to call anyone or fill out a form. Your Part A coverage starts on the first day of the month you turn 65.

Social Security mails you a Medicare card about two weeks before your coverage begins. Check the card for errors — your name, date of birth, and Social Security number should all be correct. If anything is wrong, contact Social Security right away at 1-800-772-1213 to fix it before your coverage starts.

If you do not receive your card by the time your coverage should start, you can create an account at Medicare.gov and view your enrollment information online. You can also call Medicare at 1-800-MEDICARE (1-800-633-4227) to confirm your enrollment and request a replacement card.

What to Do If You Did Not Get Part A Automatically

Some people do not receive automatic enrollment. This happens if you did not work long enough to earn Part A, if Social Security does not have a record of your work history, or if you are under 65 and do not meet the disability or kidney disease criteria. If you think you should have gotten Part A but did not, contact Social Security at 1-800-772-1213 to review your work record.

If you are not automatically enrolled and you want Part A, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. Coverage begins July 1 of that year. To enroll, call Medicare at 1-800-MEDICARE or visit Medicare.gov and sign into your account.

If you enroll during the General Enrollment Period instead of when you first became may be able to access, you will pay a higher monthly premium — 10 percent more for each year you delayed. This penalty is permanent, so it is important to enroll as soon as you become may be able to access, even if you do not plan to use it right away.

Delaying Part A If You Are Still Working

If you are 65 or older and still working, you can delay Part A enrollment without paying a penalty. This is useful if you have health insurance through your job and do not need Medicare yet. You must enroll within eight months of the date you stop working or lose your job-based coverage, whichever comes first.

To delay Part A, you do not need to do anything — just do not enroll. However, you should still create a Medicare account at Medicare.gov so you can enroll quickly when you need to. When you are ready to enroll, call Medicare at 1-800-MEDICARE or go to Medicare.gov. Your coverage will start the first day of the month after you enroll.

If you miss the eight-month window, you can still enroll during the next General Enrollment Period (January 1 to March 31), but you will pay the higher premium for delayed enrollment. The penalty applies for as long as you have Part A, so it pays to enroll on time.

Understanding Part A Costs and Coverage Limits

Part A is free for most people who paid Medicare taxes while working. You do not pay a monthly premium. However, you do pay out-of-pocket costs when you use hospital services. These costs include a deductible for each hospital stay and coinsurance for longer stays.

In 2024, you pay a $1,676 deductible per benefit period for a hospital stay. A benefit period starts when you enter the hospital and ends 60 days after you leave. If you go back to the hospital more than 60 days later, a new benefit period begins and you pay another deductible. After you pay the deductible, Part A covers all hospital costs for days 1 through 60. For days 61 through 90, you pay $419 per day. For days 91 and beyond, you pay $838 per day, up to a lifetime reserve of 60 additional days.

For skilled nursing facility care, Part A covers the first 20 days fully after a may have access to hospital stay of at least three days. For days 21 through 100, you pay $209.50 per day. After day 100, you pay all costs. These dollar amounts change each year, so check Medicare.gov for the current year's figures.

Part A and Other Medicare Coverage

Part A alone does not cover all your medical needs. It covers hospital and skilled nursing care, but it does not cover doctor visits, outpatient services, lab tests, imaging, or prescription drugs. Most people who enroll in Part A also enroll in Part B (medical insurance) to cover those services.

You have two main paths after getting Part A. You can enroll in Part B and Part D separately (called Original Medicare), or you can choose a Medicare Advantage plan (Part C), which is an all-in-one alternative that includes hospital, medical, and usually prescription drug coverage. Medicare Advantage plans are offered by private insurance companies and often have lower out-of-pocket costs, but they limit which doctors and hospitals you can use.

Your initial enrollment window for Part B is seven months long — it starts three months before the month you turn 65 and ends three months after. If you delay Part B past this window, you pay a permanent penalty of 10 percent per year for each year you delayed. Part A has no such penalty for delay, but Part B does, so it is important to enroll in Part B on time unless you have job-based coverage.

How to Check Your Part A Enrollment Status

You can check whether you are enrolled in Part A by creating an account at Medicare.gov. Go to the homepage, click "Sign In," and select "Create an account" if you do not have one. You will need your Social Security number, email address, and a phone number. Once you are logged in, click "My Medicare" and look for your enrollment information.

Your Medicare account shows your Part A coverage start date, your Medicare number, and any other coverage you have. You can also read and print your Medicare card from this account if you need a replacement. If you see an error — for example, if the coverage start date is wrong — contact Medicare at 1-800-MEDICARE to report it.

If you do not want to create an online account, you can call Social Security at 1-800-772-1213 to confirm your Part A enrollment. Have your Social Security number ready. Social Security can tell you whether you are enrolled and when your coverage begins.

Frequently Asked Questions

Do I have to enroll in Part A, or can I turn it down?

You can turn down Part A if you have job-based coverage and are still working. However, once you stop working or lose that coverage, you should enroll within eight months to avoid paying a higher premium. If you are retired and not working, it is usually best to enroll in Part A when you become may be able to access, since it is free and you may need hospital care.

What happens if I miss the enrollment important date?

If you miss your initial enrollment window and do not have a valid reason, you can enroll during the General Enrollment Period (January 1 to March 31), but your coverage will not start until July 1 and you will pay a higher monthly premium. The penalty is 10 percent of the Part A premium for each year you delayed, and it lasts for life.

Can I get Part A if I did not work 10 years?

If you did not work 10 years yourself, you may be able to get Part A on your spouse's work record if they worked 10 years and are at least 62. You can also get Part A at any age if you have received Social Security disability for 24 months, have end-stage renal disease, or have ALS. Contact Social Security to discuss your situation.

Does Part A cover nursing home care?

Part A covers skilled nursing facility care only after a hospital stay of at least three days, and only for up to 100 days per benefit period. It does not cover long-term custodial care in a nursing home. If you need ongoing nursing home care, you will need to pay out of pocket or look into Medicaid, which may cover long-term care depending on your state and income.

Can I have Part A and Medicare Advantage at the same time?

Yes. Part A is hospital insurance and is included in every Medicare Advantage plan. When you enroll in a Medicare Advantage plan, you keep your Part A coverage — the plan straightforward replaces your Part B and adds prescription drug coverage. You cannot have Original Medicare Part B and a Medicare Advantage plan at the same time, but you can have Part A with either option.