Part A covers hospital care, and it is free for most people at 65

Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. Most people who are 65 or older and have worked at least 10 years in jobs where they paid Medicare taxes do not pay a monthly premium for Part A — it comes at no cost.

You do not automatically get Part A just because you turn 65. You have to sign up during your enrollment window, which starts three months before the month you turn 65 and ends three months after. If you miss that window, you may face a penalty that raises your premium permanently. Even though Part A is free for most people, you still need to register for it.

Part A is not completely free in the way that sounds. You pay a deductible when you use it — a flat amount you cover before Medicare starts paying. For hospital stays in 2024, that deductible is $1,676 per benefit period. A benefit period starts when you enter the hospital and ends 60 days after you leave without being readmitted. If you go back to the hospital after those 60 days, a new benefit period begins and you pay the deductible again.

Key Takeaways

  • Part A is free at age 65 if you worked at least 10 years in jobs where you paid Medicare taxes, but you must sign up during your enrollment window or face a permanent penalty.
  • You pay a deductible ($1,676 in 2024) when you use Part A, and that deductible resets every 60 days if you are readmitted to the hospital.
  • Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health services, but not doctor visits or outpatient care.
  • If you did not work 10 years in Medicare-taxed jobs, you can still get Part A by paying a monthly premium, which varies based on how many years you or your spouse worked.

Who pays no premium for Part A

You pay no monthly premium for Part A if you or your spouse worked at least 10 years in jobs covered by Social Security and Medicare taxes. "Covered" means your employer withheld Medicare tax from your paycheck — most jobs in the United States are covered. You do not have to have worked those 10 years consecutively; they can be spread across your entire working life.

If you are not yet 65 but receive Social Security Disability Insurance (SSDI) or have end-stage renal disease, you may be able to get free Part A before 65. People on SSDI automatically get Part A after 24 months of receiving disability payments. People with end-stage renal disease can get Part A when ready upon diagnosis, regardless of age.

Who pays a premium for Part A

If you did not work 10 years in Medicare-taxed jobs, you can still buy Part A by paying a monthly premium. The amount depends on how many years you or your spouse worked. In 2024, the premium ranges from about $278 to $505 per month, depending on your work history. The more years you worked, the lower the premium.

You can also buy Part A if you are under 65 and not yet may be able to access through disability or kidney disease. Some people choose to buy it to cover hospital costs while they wait to turn 65 and become may be able to access for free Part A.

What Part A actually covers

Part A pays for inpatient hospital care after you meet the deductible. This includes a semi-private room, meals, nursing care, and most hospital services and supplies. It does not cover a private room unless medically necessary, and it does not cover a television or telephone in your room.

Part A also covers up to 100 days in a skilled nursing facility (a nursing home that provides medical care) after a hospital stay of at least three days. You pay nothing for the first 20 days. From day 21 to day 100, you pay a daily amount ($209.50 per day in 2024). After 100 days, you pay all costs yourself.

Hospice care is covered under Part A if you have a terminal illness and choose comfort care instead of treatment. Part A also covers some home health services — nursing care, physical therapy, and medical equipment — but only if a doctor orders it and you are homebound.

What Part A does not cover

Part A does not cover doctor visits, outpatient care, prescription drugs, or preventive services like screenings and vaccines. Those are covered under Part B (medical insurance) or Part D (prescription drug coverage). Part A also does not cover long-term custodial care in a nursing home — only skilled nursing care after a hospital stay.

Part A does not cover private duty nursing, personal care aides, or meals and lodging in a facility unless you are an inpatient. If you need ongoing help at home with bathing, dressing, or meals but do not need skilled medical care, Part A will not pay for it.

How to sign up for Part A

If you are already receiving Social Security benefits, you are automatically enrolled in Part A and Part B the month you turn 65. You do not have to do anything. Your Medicare card will arrive in the mail about two weeks before your coverage starts.

If you are not receiving Social Security, you must sign up yourself. You can do this online at Medicare.gov, by phone at 1-800-MEDICARE, or in person at your local Social Security office. Your enrollment window is three months before the month you turn 65, the month you turn 65, and three months after. If you miss this window and do not have other health coverage, you will pay a penalty on top of your premium for as long as you have Part A.

Costs beyond the deductible

After you pay the Part A deductible, Medicare covers most hospital costs. However, you may still owe money for certain things. If you stay in the hospital more than 60 days in one benefit period, you pay a daily amount ($419 per day in 2024) for days 61 through 90. If you stay longer than 90 days, you can use your "lifetime reserve days" — 60 extra days Medicare gives you once in your life — and pay an even higher daily amount ($838 per day in 2024).

These costs change every year. Medicare announces new deductibles and daily amounts each October for the year ahead. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE.

Frequently Asked Questions

Do I have to take Part A if I am still working at 65?

No. If you or your spouse are still working and have health coverage through an employer, you can delay Part A without penalty. However, once you stop working or lose that coverage, you should sign up right away. If you delay and later sign up outside your enrollment window, you will pay a penalty.

What happens if I do not sign up for Part A during my enrollment window?

You will pay a penalty equal to 10 percent of the Part A premium for twice the number of years you were late signing up. This penalty is permanent — you pay it for as long as you have Part A. For example, if you were two years late, you pay a 20 percent penalty forever.

Can I drop Part A if I do not want it?

If Part A is free, you cannot drop it once you are enrolled. If you are paying a premium for Part A, you can drop it, but you will lose coverage and may face a penalty if you sign up again later.

Does Part A cover nursing home care?

Part A covers skilled nursing care in a nursing home for up to 100 days after a hospital stay of at least three days. It does not cover long-term custodial care — help with daily activities like bathing and dressing when you do not need skilled medical care. Custodial care is usually paid out of pocket or through Medicaid.

What is the difference between Part A and Part B?

Part A is hospital insurance and covers inpatient care. Part B is medical insurance and covers doctor visits, outpatient services, and some preventive care. Most people need both. Part B does have a monthly premium, even if Part A is free.