Most people pay nothing for Medicare Part A if they or their spouse paid Medicare taxes for 10 years

Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services. If you or your spouse worked and paid Medicare taxes (the 1.45% deduction from your paycheck) for at least 10 years, you do not pay a monthly premium for Part A when you turn 65. This is called premium-free Part A, and it applies to most people who worked in the United States.

If you do not meet the 10-year requirement, you can still get Part A, but you will pay a monthly premium. The amount depends on how many quarters of Medicare tax you paid. Someone with 30 to 39 quarters of coverage pays one rate; someone with fewer than 30 quarters pays a higher rate. These amounts change each year.

Even if your premium is free, you will still pay out-of-pocket costs when you actually use hospital services. These costs are separate from the premium and are what most people need to plan for.

Key Takeaways

  • If you or your spouse paid Medicare taxes for 10 years, your Part A premium is free; if not, you pay a monthly premium based on your work history.
  • You pay a deductible each time you enter the hospital, which covers the first 60 days of a hospital stay and resets each benefit period.
  • After 60 days in the hospital, you pay a daily coinsurance amount for days 61 through 90, and a higher daily amount for days 91 and beyond.
  • Skilled nursing facility care requires a 3-day hospital stay first, and you pay nothing for the first 20 days, then a daily coinsurance amount for days 21 through 100.
  • These dollar amounts change every January, so check the current figures on Medicare.gov before you need care.

Hospital stay costs: deductible and daily coinsurance

When you are admitted to the hospital, you pay a deductible for each 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 all your hospital costs for the first 60 days — you pay nothing else during that time.

If you stay in the hospital longer than 60 days, you pay a daily coinsurance amount for days 61 through 90. This is a fixed dollar amount per day, not a percentage of your bill. If you stay even longer, from day 91 onward, the daily coinsurance is higher. Medicare Part A covers up to 150 days total per benefit period; after that, you pay all costs yourself.

These amounts are set by Medicare and change each January. Because the numbers shift yearly, you should check the current deductible and coinsurance amounts on Medicare.gov or call 1-800-MEDICARE before a planned hospital stay so you know what to expect.

Skilled nursing facility costs after a hospital stay

If you need skilled nursing care after leaving the hospital — for example, physical therapy or wound care — Medicare Part A covers a skilled nursing facility (SNF) stay, but only if you were admitted to the hospital first and stayed at least 3 days. The 3-day stay must be for the same condition you need the SNF care for.

You pay nothing for the first 20 days in the SNF. From day 21 through day 100, you pay a daily coinsurance amount. After day 100 in a benefit period, Medicare stops paying and you pay all costs. Like hospital coinsurance, this daily amount changes each year.

Many people assume Medicare covers all nursing home care, but it does not. Part A covers only skilled care — medical care you need because of an acute condition. Long-term custodial care, where you need help with daily living but not medical treatment, is not covered by Part A and is not covered by any part of Original Medicare.

Home health and hospice costs

Medicare Part A covers home health services — such as nursing visits, physical therapy, or medical equipment — if a doctor orders them and you are homebound. You pay nothing for home health services covered by Part A. Medicare pays the home health agency directly.

Hospice care for people with a terminal illness is also covered by Part A with no premium or deductible. You may pay a small coinsurance amount for prescription drugs and inpatient respite care (a short hospital stay to give your caregiver a break), but these costs are capped and usually modest.

What happens if you do not have the 10-year work history

If you do not have 10 quarters of Medicare-covered work, you can still get Part A by paying a monthly premium. The premium amount depends on how many quarters you do have. Someone with 30 to 39 quarters pays one rate; someone with fewer than 30 quarters pays a higher rate. Both rates are higher than the premium for someone who qualifies for premium-free Part A.

You can also get Part A without a work history if you have been on Social Security disability for 24 months, if you have end-stage renal disease, or if you have ALS (amyotrophic lateral sclerosis). Each of these paths has its own rules about when coverage begins.

If you are not yet 65 and do not fall into one of these categories, you cannot get Part A. You would need to wait until 65 or find coverage through your employer, a spouse's employer, or the marketplace.

How Part A costs compare to other coverage options

Part A is one piece of Original Medicare. If you choose Original Medicare, you also need Part B (doctor visits and outpatient care), which has a monthly premium and separate deductibles. Many people add Part D (prescription drug coverage) and Medigap (supplemental insurance) to cover costs Part A and Part B do not pay.

Alternatively, you can choose a Medicare Advantage plan (Part C), which is an all-in-one alternative to Original Medicare. Medicare Advantage plans include Part A and Part B coverage, usually with lower or no premiums, but they have different cost structures — typically copays instead of deductibles and coinsurance, and they limit which doctors and hospitals you can use.

The choice between Original Medicare and Medicare Advantage depends on your health, your doctors, and how much out-of-pocket cost you can handle. Neither option is automatically cheaper; it depends on your situation.

Tracking your costs and planning ahead

Part A costs are predictable if you plan ahead. Before a hospital or skilled nursing stay, ask the hospital or facility what your out-of-pocket costs will be. They can tell you the current deductible and coinsurance amounts and estimate your bill based on your expected length of stay.

Keep a record of your hospital and SNF stays and the dates they occur. This helps you track when benefit periods end and when a new deductible will explore. If you have Medigap or Medicare Advantage, your supplemental plan may cover some or all of these costs, so check your plan documents to see what you are responsible for.

Medicare.gov has a tool called the Plan Finder where you can see current Part A costs and compare plans. You can also call 1-800-MEDICARE to speak with someone who can walk you through the numbers for your situation.

Frequently Asked Questions

Do I pay Part A costs every month like a regular bill?

No. If your premium is free, you pay nothing monthly. If you do pay a premium because you do not have 10 years of work history, that premium is deducted from your Social Security check each month. The deductible and coinsurance only appear when you actually use hospital or skilled nursing services.

If I have Medigap, do I still pay the Part A deductible?

That depends on your Medigap plan. Some Medigap plans cover the Part A deductible; others do not. Check your plan documents or call your Medigap insurer to see what they cover. This is one reason people choose Medigap — to reduce out-of-pocket costs.

What if I was self-employed — do I still get premium-free Part A?

Yes, if you paid self-employment tax (which includes Medicare tax) for 10 years or more. Self-employed people pay both the employer and employee share of Medicare tax, so your quarters of coverage count the same way as someone who was an employee.

Can Part A costs change during the year?

No. The deductible, coinsurance, and premium amounts are set each January and do not change until the following January. However, if you have a new benefit period (which starts when you enter the hospital), you pay the deductible that is in effect at that time.

Does Part A cover a hospital stay for COVID-19 or other infectious disease?

Yes. Part A covers hospital stays for any condition, including infectious diseases. You pay the same deductible and coinsurance as you would for any other hospital stay. If you also have Part B, it covers the doctor's services during that stay.