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. It is the hospital insurance piece of Original Medicare. Most people do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working — at least 40 quarters (10 years) of work history qualifies you.

Part A is automatic. When you turn 65 and are a U.S. citizen or permanent resident, you are enrolled in Part A whether you sign up or not. If you delay enrolling in other parts of Medicare, Part A still starts at 65. You pay for Part A through the taxes you paid during your working years, not through a separate bill each month.

Part A does not cover doctor visits, outpatient care, prescription drugs, or long-term custodial care in a nursing home. Those gaps are why most people also carry Part B (medical insurance) or a Medigap policy. Understanding what Part A does and does not cover helps you know what other coverage you need.

Key Takeaways

  • Part A covers hospital stays, skilled nursing care after hospitalization, hospice services, and some home health visits, but not routine doctor visits or prescription drugs.
  • Most people pay no monthly premium for Part A because they paid Medicare taxes during their working years.
  • You are automatically enrolled in Part A at age 65 if you are a U.S. citizen or permanent resident, even if you do not sign up.
  • Part A has a deductible per hospital stay and copayments for skilled nursing and hospital days beyond the first 60, so you may want additional coverage.
  • Part A alone does not cover doctor visits, so most people pair it with Part B or a Medigap policy to avoid large out-of-pocket costs.

What Part A covers: inpatient hospital and skilled nursing care

Part A pays for a hospital room, meals, nursing care, and standard medical equipment during an inpatient hospital stay. An inpatient stay means you are admitted to the hospital and assigned a bed; it does not include emergency room visits where you are treated and sent home. Part A covers the full cost of your hospital room and care after you pay the deductible, which changes each year.

Part A also covers skilled nursing facility (SNF) care — a nursing home stay — but only if it follows a hospital stay of at least three days and is medically necessary. The first 20 days are fully covered. Days 21 through 100 require a copayment per day. After day 100 in the same benefit period, you pay all costs. Many people do not realize this limit and assume nursing home care is covered indefinitely.

Part A covers hospice care for people with a terminal illness expected to live six months or less. You pay little to nothing for hospice services, though you may pay a small copayment for drugs and respite care. Part A also covers some home health services — nursing visits, physical therapy, and medical equipment — if you are homebound and a doctor orders the care. Home health visits are covered in full with no copayment.

What Part A does not cover

Part A does not pay for doctor office visits, lab tests, X-rays, or outpatient procedures. Those are covered under Part B, which is medical insurance. If you go to a doctor's office or an urgent care clinic, Part A does not explore.

Part A does not cover long-term custodial care in a nursing home — care that is not skilled medical care but rather help with daily living. If you need a nursing home for supervision and information with bathing, dressing, and meals but not active medical treatment, Part A will not pay. This is one of the largest gaps in Medicare coverage and is why many people buy long-term care insurance or Medigap policies.

Part A does not cover prescription drugs. You need Part D (prescription drug coverage) for that. Part A also does not cover dental, vision, hearing aids, or routine foot care, though some of these may be covered under a Medicare Advantage plan.

Part A costs: deductibles and copayments

Most people pay no monthly premium for Part A. However, you do pay out-of-pocket costs when you use it. The deductible — the amount you pay before Part A starts paying — applies per hospital stay and changes each year. Once you pay the deductible, Part A covers all hospital costs for days 1 through 60.

Days 61 through 90 of a hospital stay require a copayment per day. Days 91 and beyond require a higher copayment per day, and you have a lifetime reserve of 60 additional days you can use. After your lifetime reserve is exhausted, you pay all costs. For skilled nursing facilities, you pay nothing for days 1 through 20, then a copayment per day for days 21 through 100.

If you have limited income, you may be able to reduce these costs through Medicaid, which can pay your Part A deductible and copayments. Each state runs Medicaid differently, so contact your state Medicaid office to learn whether you may have access to.

When Part A starts and how to enroll

Part A starts automatically on the first day of the month you turn 65, as long as you are a U.S. citizen or permanent resident with at least five years of residency. You do not have to do anything to enroll — Social Security handles it. You will receive a Medicare card in the mail before your coverage begins.

If you are still working at 65 and have health insurance through your employer, you can delay Part B but not Part A. Part A enrollment is automatic and cannot be delayed. If you are not yet receiving Social Security, you should contact Social Security about three months before you turn 65 to make sure your enrollment is processed on time.

If you are not a U.S. citizen or permanent resident, you may not be able to enroll in Part A at 65. Speak with Social Security about your specific situation.

Part A and Original Medicare versus Medicare Advantage

Part A is part of Original Medicare, which is run by the federal government. When you use Original Medicare, you can see any doctor or hospital that accepts Medicare. You pay the deductible and copayments out of pocket, and you are responsible for finding and paying for additional coverage like Part B and Part D.

If you choose a Medicare Advantage plan (Part C) instead, you are still enrolled in Part A, but the Advantage plan becomes your primary coverage. The plan sets its own deductibles, copayments, and rules about which hospitals and doctors you can use. Many Advantage plans include Part D (drug coverage) and some dental or vision benefits, but you may pay more out of pocket for hospital stays or specialist visits.

You cannot have both Original Medicare and Medicare Advantage at the same time. You must choose one or the other during your initial enrollment period or during the annual open enrollment period in the fall.

Common mistakes and how to avoid them

Many people assume Part A covers nursing home care indefinitely and are shocked to learn the 100-day limit. If you think you may need nursing home care, understand this limit now and consider long-term care insurance or a Medigap policy that covers skilled nursing copayments.

Another common mistake is not enrolling in Part B on time. Part A is automatic, but Part B is not. If you delay Part B without a valid reason (such as employer coverage), you will pay a penalty for the rest of your life. The penalty is 10 percent of the Part B premium for each year you delayed.

Some people do not realize that Part A has an annual deductible per hospital stay, not per year. If you are hospitalized twice in one year, you pay the deductible both times. Planning for this cost helps you avoid surprise bills.

Frequently Asked Questions

Do I have to pay for Part A if I did not work long enough?

If you have fewer than 40 quarters of work history, 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 coverage. Contact Social Security to find out your work history and whether you may have access to for premium-free Part A.

What happens to Part A if I move out of the country?

Part A generally does not cover care outside the United States, except in rare cases involving Canada or Mexico. If you plan to live abroad, speak with Medicare about your coverage options before you move.

Can I use Part A at any hospital?

Yes, with Original Medicare Part A you can use any hospital that accepts Medicare. With a Medicare Advantage plan, you may be limited to hospitals in the plan's network, so check your plan documents before choosing a hospital.

Does Part A cover emergency room visits?

Part A covers emergency room visits only if you are admitted to the hospital as an inpatient. If you are treated in the emergency room and sent home, Part B covers the visit, not Part A. This is an important distinction because it affects your out-of-pocket cost.

What if I cannot afford the Part A deductible?

If your income is low, Medicaid may pay your Part A deductible and copayments. You can also ask the hospital's financial counselor about payment plans or charity care programs. Do not ignore the bill — contact the hospital as soon as you receive it.