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

Part A (hospital insurance) does not charge a monthly premium if you or your spouse paid Medicare taxes for at least 10 years while working. You get Part A automatically when you turn 65 if you are a U.S. citizen or permanent resident. However, "free" does not mean "no costs." You will pay a deductible each time you are admitted to a hospital, and you will pay coinsurance (a daily amount) if your stay is longer than a certain number of days.

If you did not work long enough to may have access to for premium-free Part A, you can still buy it. The monthly premium in 2024 ranges from about $278 to $557, depending on how many quarters of work history you have. The exact amount changes each year.

Key Takeaways

  • Part A has no monthly premium if you worked and paid Medicare taxes for at least 10 years, but you will pay a deductible and coinsurance when you use hospital services.
  • The Part A deductible for a hospital stay is a single amount per benefit period, not per day, and it applies to the first 60 days of your hospital stay.
  • If your hospital stay goes beyond 60 days, you will pay a daily coinsurance amount for days 61 through 90, and a higher daily amount for days 91 through 150.
  • People who did not work long enough to earn premium-free Part A can purchase it, with premiums ranging from roughly $278 to $557 per month depending on work history.
  • Skilled nursing facility care, home health care, and hospice are covered under Part A with different cost rules than hospital stays.

What the Part A deductible covers

When you are admitted to a hospital, you pay one deductible amount for the entire stay, no matter how many days you are there. In 2024, that deductible is $1,632 per benefit period. A benefit period starts the day 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 the deductible again.

The deductible covers days 1 through 60 of your hospital stay. After you pay it, Part A covers the rest of your hospital bills for those first 60 days — room, meals, tests, surgery, and medications given in the hospital. You do not pay anything more for those services during days 1 through 60.

These amounts change each year. Medicare announces the new deductible in the fall for the year ahead, so check your annual notice or visit Medicare.gov to see the current year's amount.

Coinsurance costs for longer hospital stays

If you stay in the hospital longer than 60 days, you enter a period where you share the cost with Medicare. For days 61 through 90, you pay a daily coinsurance amount. In 2024, that is $408 per day. Medicare covers the rest; you are responsible only for that daily amount.

If your stay extends beyond 90 days, you have access to 60 additional "lifetime reserve days." These are days you can use only once in your lifetime. For each lifetime reserve day you use (days 91 through 150), you pay a higher daily coinsurance amount — $816 per day in 2024. After you use all 60 lifetime reserve days, you pay all costs for any additional hospital days.

Most hospital stays end well before day 60, so most people never pay coinsurance. But for serious illnesses or injuries requiring extended care, these costs can add up quickly. This is one reason many people buy Medigap (supplemental insurance) or enroll in a Medicare Advantage plan — both can help cover these out-of-pocket costs.

Other Part A services and their costs

Part A covers more than just hospital stays. It also covers skilled nursing facility care (if you need rehabilitation after a hospital stay), home health care, and hospice services. Each has its own cost structure.

For skilled nursing facility care, you pay nothing for days 1 through 20 after a may have access to hospital stay. For days 21 through 100, you pay a daily coinsurance amount ($204 per day in 2024). After day 100, you pay all costs. Home health care and hospice have different rules — you typically pay nothing for the services themselves, but you may pay a small coinsurance for prescription drugs or medical equipment.

If you do not may have access to for premium-free Part A

You may not have premium-free Part A if you did not work long enough in a job covered by Medicare taxes, or if you are not yet 65 and do not have end-stage renal disease or ALS. In these cases, you can buy Part A, but you will pay a monthly premium on top of the deductible and coinsurance costs.

If you worked 30 to 39 quarters (roughly 7.5 to 10 years), your premium is lower than if you worked fewer than 30 quarters. The exact premium depends on your work history and changes yearly. You can contact Social Security or visit Medicare.gov to find out whether you may have access to for premium-free Part A and what your premium would be if you do not.

How Part A fits with other Medicare coverage

Part A alone covers hospital and some post-hospital care, but it does not cover doctor visits, outpatient services, or prescription drugs. Most people pair Part A with Part B (medical insurance), which has its own monthly premium and covers those services. Together, Original Medicare (Part A and Part B) leaves you responsible for deductibles, coinsurance, and copayments.

If you want to limit your out-of-pocket costs, you have two main paths. You can buy a Medigap plan, which works alongside Original Medicare and covers many of the costs Part A and Part B do not. Or you can enroll in a Medicare Advantage plan, which replaces Original Medicare and typically has lower or no premiums but different cost-sharing rules and network restrictions.

Frequently Asked Questions

Do I have to pay for Part A if I already paid Medicare taxes while working?

No. If you or your spouse paid Medicare taxes for at least 10 years, you receive Part A at no monthly cost when you turn 65. You will still pay the deductible and coinsurance when you use hospital services, but there is no premium.

What happens if my hospital stay goes past 90 days?

You can use up to 60 lifetime reserve days, paying a higher daily coinsurance for each one. Once those are gone, you pay all remaining hospital costs yourself. Most people never use all their reserve days, but for very long stays, this can become expensive.

Can I reduce my Part A costs?

Yes. Buying a Medigap plan can cover your deductible and coinsurance. A Medicare Advantage plan replaces Part A and Part B with different cost rules, often with lower out-of-pocket maximums. Compare your options during your enrollment period to see what works for your situation.

Do I pay Part A costs if I am in a nursing home?

Only if you are in a skilled nursing facility for rehabilitation after a hospital stay. If you are in a long-term care or custodial facility, Part A does not cover it, and you pay out of pocket or through Medicaid if you may have access to.

What if I did not work long enough to get premium-free Part A?

You can buy Part A with a monthly premium. The amount depends on how many quarters you worked — roughly 30 to 39 quarters costs less than fewer than 30 quarters. Contact Social Security to learn your specific premium and whether you are close to may have access to for premium-free coverage.