What Medicare Part A Covers and How Hospital Insurance Works

Medicare Part A is hospital insurance, paid for through payroll taxes

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working. Part A is automatic — you are enrolled when you turn 65 and sign up for Medicare, unless you are still working and covered by an employer plan.

Part A works differently from Part B (doctor visits) and Part D (prescriptions). Instead of paying a copay each time you use a service, you pay a deductible once per benefit period, then Medicare covers most of the cost. A benefit period starts the day you enter the hospital and ends 60 days after you leave without returning.

Key Takeaways

Part A covers hospital stays, skilled nursing care after hospitalization, home health services, and hospice — but not routine doctor visits or prescriptions.
You pay a deductible per benefit period (currently $1,556 for 2024, though this amount changes yearly), then Medicare covers the full cost of most inpatient services.
If you stay in the hospital longer than 60 days in one benefit period, you begin paying coinsurance — a daily amount that increases the longer you stay.
Part A does not cover long-term custodial care in a nursing home, only skilled nursing care ordered by a doctor after a hospital stay of at least three days.

What Part A pays for: hospital and facility care

Part A covers a hospital room, meals, nursing care, and standard medical equipment during an inpatient stay. It also covers blood transfusions, surgery, anesthesia, and lab tests performed while you are admitted. The coverage is broad for acute care — treatment of sudden illness or injury that requires a hospital bed.

Part A also covers skilled nursing facility (SNF) care after you leave the hospital, but only if a doctor orders it and you have been in the hospital for at least three consecutive days first. SNF care is different from a nursing home where someone lives long-term. It is short-term rehabilitation — physical therapy, occupational therapy, or nursing care you need to recover from surgery or illness. Medicare covers the full cost of SNF care for the first 20 days, then you pay coinsurance ($194.50 per day in 2024) for days 21 through 100 in one benefit period.

Part A also covers home health services — a nurse or therapist visiting your home to provide medical care — if a doctor orders it and you are homebound. You pay nothing for home health services covered by Part A. Hospice care for terminal illness is also covered, with you paying only for drugs and respite care.

How you pay: deductibles and coinsurance

You pay a deductible at the start of each benefit period. Once you meet the deductible, Medicare covers 100 percent of most inpatient hospital costs for days 1 through 60. The deductible amount changes each year — it was $1,556 in 2024. You pay this once per benefit period, not once per hospital stay, so if you are admitted twice in the same benefit period, you do not pay the deductible twice.

If you stay in the hospital longer than 60 days in one benefit period, you begin paying coinsurance — a daily amount. For days 61 through 90, you pay a set amount per day (in 2024, $389 per day). If you stay beyond 90 days, you can use your lifetime reserve days — 60 extra days Medicare gives you once in your lifetime. You pay more coinsurance for reserve days ($778 per day in 2024). After your lifetime reserve days are used, you pay all costs.

These dollar amounts change every January. The Social Security Administration announces the new amounts in the fall, and your Medicare materials will show your specific costs.

What Part A does not cover

Part A does not cover long-term custodial care — help with bathing, dressing, and daily living in a nursing home or assisted living facility. It covers only skilled nursing care ordered by a doctor after a hospital stay. If you need help with activities of daily living but do not need medical care, Part A will not pay.

Part A also does not cover private duty nursing, a private hospital room (unless medically necessary), or most dental work, hearing aids, or eyeglasses. It does not cover routine doctor visits — that is Part B. Prescription drugs are Part D.

When Part A starts and how to enroll

You are automatically enrolled in Part A when you turn 65, as long as you have been a U.S. citizen or permanent resident for at least five years and you sign up for Social Security or Railroad Retirement benefits. You do not have to do anything — enrollment is automatic.

If you are still working at 65 and covered by an employer health plan, you can delay Part A enrollment without penalty. Once you leave that job or lose the coverage, you have eight months to enroll in Part A without a late penalty. If you miss that window, you may pay a penalty for as long as you have Medicare.

If you did not pay Medicare taxes for 10 years, you can still buy Part A at age 65, but you will pay a monthly premium. The premium is higher if you have fewer than 30 quarters of Medicare tax history.

Part A and other coverage: how it works together

Part A works alongside Part B and Part D, not instead of them. Most people have all three. Part A covers hospital and facility care; Part B covers doctor visits, outpatient services, and preventive care; Part D covers prescription drugs. Together they form Original Medicare.

Some people choose a Medicare Advantage plan (Part C) instead, which is a private insurance plan that includes hospital, doctor, and usually prescription coverage in one plan. If you have Advantage, you do not use Part A directly — the Advantage plan handles all claims. You still pay the Part A deductible if you are hospitalized, but the Advantage plan sets the amount.

If you have a Medigap policy (supplemental insurance), it works with Part A to cover some of the costs you would otherwise pay — deductibles, coinsurance, and copays. Medigap does not replace Part A; it fills in gaps.

Frequently Asked Questions

Do I have to pay for Part A if I worked long enough?

No. If you or your spouse paid Medicare taxes for at least 10 years, Part A is free. You pay only when you use it — the deductible and any coinsurance. If you have fewer than 10 years of Medicare tax history, you can buy Part A, but you will pay a monthly premium.

What happens if I stay in the hospital for more than 90 days?

After 90 days, you can use your lifetime reserve days — 60 extra days Medicare provides once in your lifetime. You pay coinsurance for each reserve day. Once reserve days are exhausted, you pay all hospital costs yourself. This is why some people buy Medigap or Advantage plans — to cover costs beyond what Part A pays.

Does Part A cover a nursing home?

Part A covers skilled nursing facility care only — short-term rehabilitation after a hospital stay of at least three days. It does not cover long-term custodial care or assisted living. If you need ongoing help with daily living, Medicaid may cover it, but Part A will not.

Can I delay Part A if I am still working?

Yes. If you are covered by an employer health plan at 65, you can delay Part A without penalty. Once you leave that job or lose coverage, you have eight months to enroll. After that window closes, you may pay a permanent penalty.

What is the difference between Part A and Part B?

Part A is hospital insurance — it covers inpatient stays, skilled nursing, home health, and hospice. Part B is medical insurance — it covers doctor visits, outpatient services, lab tests, and preventive care. Most people have both.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.