Medicare Part A is free for most people, but you may owe money when you use it

Medicare Part A — hospital insurance — does not charge a monthly premium for most people who are 65 or older. You do not pay to have Part A coverage. However, Part A does come with cost-sharing: when you go to the hospital or skilled nursing facility, you pay a deductible and daily copayments out of your own pocket. The amount you owe depends on how long you stay and what type of care you receive.

If you worked for at least 10 years and paid Medicare taxes, or if your spouse did, you may have access to for premium-free Part A. If you did not work that long, you can still buy Part A, but you will pay a monthly premium — either about $278 or $505 per month in 2024, depending on your work history. The premium amount changes each year.

Key Takeaways

  • Most people 65 and older pay no monthly premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years.
  • Part A is free to have, but you pay a deductible ($1,676 in 2024) each time you enter the hospital, and daily copayments if you stay longer than a certain number of days.
  • Skilled nursing facility care, home health, and hospice also have cost-sharing amounts that vary by the type and length of care.
  • 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 ranges from about $278 to $505 depending on your work history.

Who gets Part A without paying a monthly premium

You do not pay a monthly premium for Part A if you are 65 or older and you (or your spouse) worked and paid Medicare taxes for at least 10 years. This is the most common situation. You become may be able to access for premium-free Part A automatically when you turn 65, even if you have not yet claimed Social Security.

If you are under 65, you may also get premium-free Part A if you have received Social Security Disability Insurance (SSDI) for at least 24 months, or if you have end-stage renal disease (ESRD) or ALS (amyotrophic lateral sclerosis). Railroad workers who paid railroad retirement taxes may also may have access to.

If you do not meet these conditions, you can still buy Part A. The monthly premium depends on how many years you or your spouse worked and paid Medicare taxes. If you worked fewer than 30 quarters (roughly 7.5 years), the premium is higher — about $505 per month in 2024. If you worked 30 to 39 quarters, it is lower — about $278 per month. These amounts change each year.

What you pay when you use Part A services

Part A covers inpatient hospital stays, skilled nursing facility care, home health services, and hospice. You do not pay a premium, but you do pay when you use these services.

For a hospital stay, you pay a deductible of $1,676 per benefit period in 2024. 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 owe another deductible. After you pay the deductible, you pay nothing for days 1 through 60. For days 61 through 90, you pay a daily copayment of $419 per day in 2024. If you stay longer than 90 days, you enter "lifetime reserve days" — you have 60 of these over your entire life, and you pay $838 per day for each one you use.

For skilled nursing facility care (not regular nursing home care), you pay nothing for the first 20 days after a hospital stay of at least 3 days. For days 21 through 100, you pay $209.50 per day in 2024. After 100 days, Part A pays nothing and you pay all costs yourself.

Home health services are covered at no cost to you if a doctor orders them and you meet certain conditions — you must be homebound and need skilled care. Hospice is also covered at no cost, though you may pay small copayments for drugs and respite care.

How cost-sharing amounts change each year

The deductible and daily copayment amounts for Part A change every January. Medicare announces the new amounts in the fall of the previous year. In 2024, the hospital deductible is $1,676. In 2023, it was $1,600. The amounts go up most years because of inflation and changes in hospital costs.

You can find the current year's amounts on Medicare.gov, or you can call Medicare at 1-800-MEDICARE (1-800-633-4227) to ask. Your Medicare Summary Notice, which you receive each year, also lists the current deductible and copayment amounts.

Ways to reduce what you pay out of pocket

Medigap (supplemental insurance) and Medicare Advantage plans can help pay Part A costs. Medigap plans are sold by private insurance companies and are designed to cover the deductibles and copayments that Original Medicare (Part A and Part B) leaves you to pay. If you have a Medigap plan, you may pay little or nothing when you use Part A services. Medigap plans do charge a monthly premium, so you pay for the coverage upfront.

Medicare Advantage plans (Part C) are an alternative to Original Medicare. They include Part A and Part B coverage, usually with lower monthly premiums or no premium at all, but they often have higher copayments when you use services. Some Medicare Advantage plans cover the full Part A deductible; others do not.

If your income is low, you may also may have access to for Medicaid, your state's health program for people with limited income and resources. Medicaid can pay your Part A premium (if you buy it) and help cover your cost-sharing amounts. Each state runs Medicaid differently, so the rules vary by where you live.

What happens if you do not sign up for Part A when you turn 65

If you are may be able to access for premium-free Part A and you do not sign up when you turn 65, you can still sign up later without penalty — Part A does not have a late enrollment penalty the way Part B does. However, you will not have coverage during the months you were not signed up, so any hospital or skilled nursing care you received during that time will be your full responsibility.

If you are still working at 65 and have health insurance through your job, you can delay signing up for Part A without losing coverage. Once you leave your job or lose that insurance, you have 8 months to sign up for Part A without penalty.

Frequently Asked Questions

Do I have to pay for Part A if I am still working at 65?

No. If you are may be able to access for premium-free Part A, you do not pay a monthly premium whether you are working or not. However, you must sign up for Part A to have coverage. If you are covered by your employer's health plan, you can delay signing up, but once you leave that job, you should sign up within 8 months to avoid gaps in coverage.

What is the difference between the Part A deductible and copayments?

The deductible is a flat amount you pay once per benefit period before Part A starts paying — $1,676 in 2024. Copayments are daily charges you owe for each day you stay in the hospital after day 60, or in a skilled nursing facility after day 20. They are separate from the deductible and add up based on how long you stay.

If I buy Part A because I did not work long enough, do I also have to buy Part B?

No. You can buy Part A without Part B. However, Part B (medical insurance) covers doctor visits and outpatient care that Part A does not. Most people who buy Part A also buy Part B, but it is not required. You will pay a separate monthly premium for each one.

Does Part A cover a regular nursing home?

Part A covers skilled nursing facility care only — care that requires a nurse or therapist and follows a hospital stay of at least 3 days. It does not cover custodial care in a regular nursing home, such as help with bathing or dressing. Custodial care is not covered by Medicare at all and is your responsibility to pay for.

Can I use my lifetime reserve days if I run out of regular hospital days?

Yes. If you stay in the hospital longer than 90 days in one benefit period, you can use your 60 lifetime reserve days. Once you use a reserve day, it is gone forever — you cannot get it back. After your 60 lifetime reserve days are used up, you pay all hospital costs yourself. Most people never use all their reserve days.