What Medicare Part A Covers

Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some 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 if you are already receiving Social Security benefits.

Part A pays the bulk of the cost for a hospital stay after you meet your deductible, which changes each year. In 2024, the deductible is $1,632 per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave without returning. If you go back to the hospital after those 60 days, a new benefit period begins and you pay a new deductible.

For skilled nursing care — rehabilitation in a facility after a hospital stay — Part A covers the first 20 days completely and days 21 through 100 with a daily copay. You must have spent at least three consecutive days in the hospital first, and a doctor must order the skilled care. Part A does not cover custodial care, which is help with bathing, dressing, or eating when that is the only service you need.

Key Takeaways

  • Part A covers hospital stays, skilled nursing facilities, hospice, and some home health services, with no monthly premium if you worked and paid taxes for 10 years.
  • You pay a deductible per benefit period (a hospital stay plus 60 days), not per day, and the amount resets if you return to the hospital after 60 days.
  • Skilled nursing care is covered only after a three-day hospital stay and only if ordered by a doctor, with full coverage for the first 20 days and copays for days 21 to 100.
  • Part A does not cover long-term custodial care, assisted living, or nursing home care that is not skilled rehabilitation.

When You Automatically Enroll in Part A

If you are receiving Social Security benefits, Medicare automatically enrolls you in Part A and Part B the month you turn 65. You do not have to do anything. Your Medicare card arrives in the mail about two weeks before your 65th birthday.

If you are not yet receiving Social Security, you must contact Social Security to enroll in Medicare. You can do this online at ssa.gov, by phone at 1-800-772-1213, or in person at your local Social Security office. Enroll in the three months before you turn 65, the month you turn 65, or the three months after — this is your initial enrollment period. If you miss this window and do not have other health coverage, you may pay a late enrollment penalty for as long as you have Medicare.

How Part A Deductibles and Copays Work

Part A uses a benefit period system instead of a calendar year. Your first benefit period starts the day you enter the hospital. You pay the full deductible amount before Part A begins to pay. After you meet the deductible, Part A covers all hospital costs for days 1 through 60 of that stay.

If you stay longer than 60 days in the same hospital stay, you pay a daily copay for days 61 through 90. If you need to stay past 90 days, you can use your lifetime reserve days — Medicare gives you 60 of these for your entire life. Once you use a lifetime reserve day, it is gone forever. After your lifetime reserve days run out, you pay the full cost of the hospital stay.

Your benefit period ends 60 days after you leave the hospital without being readmitted. If you return to the hospital after those 60 days have passed, a new benefit period starts and you pay a new deductible. This means you could pay two deductibles in one calendar year if you have two separate hospital stays.

Skilled Nursing Facility Coverage and Limits

Part A covers a stay in a skilled nursing facility only if three conditions are met: you spent at least three consecutive days in the hospital first, you were admitted to the facility within 30 days of leaving the hospital, and a doctor orders the skilled care. Skilled care means medical services like physical therapy, occupational therapy, or wound care — not just help with daily living.

Part A pays the full cost of the first 20 days. For days 21 through 100, you pay a daily copay (in 2024, this is $204 per day). After day 100 of the same benefit period, you pay all costs yourself. If you need more care after 100 days, you would need to pay out of pocket or use other insurance.

The facility must be Medicare-certified for Part A to pay. Most hospitals can tell you which skilled nursing facilities accept Medicare, or you can search the Medicare Care Compare tool at Medicare.gov.

Home Health Services and Hospice Care

Part A covers home health services when a doctor orders them and you are homebound — meaning you cannot leave home without help or it would be medically inadvisable. Services include nursing care, physical therapy, occupational therapy, and speech therapy. You do not pay a copay for home health services covered by Part A, though you may pay a copay for any equipment like oxygen or a walker.

Hospice care is covered by Part A when a doctor certifies that you have six months or less to live. Part A covers doctor visits, nursing care, pain medication, counseling, and some equipment and supplies. You pay nothing for hospice care itself, though you may pay a small copay for prescription drugs and inpatient respite care (a short hospital stay to give your caregiver a break).

What Part A Does Not Cover

Part A does not cover custodial care — help with bathing, dressing, eating, or toileting when that is the only service you need. It does not cover assisted living facilities, independent living communities, or long-term nursing home care unless that care is skilled rehabilitation ordered by a doctor. Part A also does not cover private duty nursing, personal care attendants, or care in your home that is not ordered by a doctor.

If you need long-term care, you would need to pay out of pocket, use Medicaid (which does cover long-term care in some cases), or have a long-term care insurance policy. Some people use a combination of Medicare, Medicaid, and their own savings to pay for extended care.

Part A and Other Insurance

If you have both Medicare Part A and employer health insurance or union coverage, Medicare is usually the primary payer — it pays first. Your other insurance pays second. Tell your doctor's office and hospital about all your insurance so they bill in the correct order.

If you have Medicaid in addition to Medicare, Medicaid may help pay your Part A deductibles and copays, depending on your state and income. Contact your state Medicaid office to learn what it covers in your situation.

Frequently Asked Questions

Do I have to pay for Part A if I did not work 10 years?

If you did not pay Medicare taxes for 10 years yourself, you may still be covered through your spouse's work history. If neither you nor your spouse has 10 years of work history, you can buy Part A by paying a monthly premium, which varies based on how many years of coverage you have. Contact Social Security to learn your premium amount.

What happens if I go to the hospital twice in one year?

If your second hospital stay begins more than 60 days after you left the hospital the first time, a new benefit period starts and you pay a new deductible. If the second stay is within 60 days, it is part of the same benefit period and you do not pay another deductible, but you may pay copays if your stay is very long.

Does Part A cover physical therapy at home?

Yes, if a doctor orders it and you are homebound. Part A covers the full cost of home health physical therapy with no copay. The therapist must work for a Medicare-certified home health agency.

Can I use Part A at any hospital?

Part A works at any hospital that accepts Medicare, which is nearly all hospitals in the United States. If you travel or move, your Part A coverage follows you. Show your Medicare card at any Medicare-certified facility.

What is the difference between Part A and Part B?

Part A is hospital insurance covering inpatient stays and skilled nursing care. Part B is medical insurance covering doctor visits, outpatient services, and preventive care. Most people have both, and Part B has a monthly premium of $164.90 in 2024 (the amount may be higher based on your income).