Medicare Part A is hospital insurance, paid for through payroll taxes
Medicare Part A is the hospital insurance portion of Medicare. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people who worked and paid Medicare taxes for at least 10 years receive Part A automatically at age 65, with no monthly premium.
Part A is different from Part B (doctor visits and outpatient care) and Part D (prescription drugs). You can have Part A without the other parts, though most people who are may be able to access for Medicare end up with multiple parts. Part A is funded through the Medicare tax that comes out of your paycheck — 1.45% from you and 1.45% from your employer, or 2.9% if you are self-employed.
Key Takeaways
- Part A covers hospital stays, skilled nursing care after hospitalization, hospice, and some home health services, but not routine doctor visits or prescription drugs.
- You pay nothing for Part A if you worked and paid Medicare taxes for at least 10 years, and it starts automatically at age 65.
- Part A has a deductible per hospital stay (not per day), and you pay coinsurance for stays longer than 60 days.
- You must be enrolled in Part A to use hospital services covered by Medicare, and enrollment happens automatically unless you decline it.
- Part A does not cover the full cost of a hospital stay — you are responsible for the deductible and coinsurance amounts.
What Part A actually covers in a hospital stay
When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications given in the hospital, and medical equipment and supplies used during your stay. It also covers lab tests, X-rays, and surgery performed in the hospital. The coverage applies to any hospital that accepts Medicare, which includes nearly all hospitals in the United States.
Part A does not cover private rooms unless medically necessary, television or phone charges, or personal care items you bring from home. If you go to a hospital that does not accept Medicare, Part A will not pay anything — you are responsible for the full bill. Before choosing a hospital for a planned procedure, you can call ahead to confirm it accepts Medicare.
Skilled nursing facility care after hospitalization
Part A covers care in a skilled nursing facility (SNF) — a nursing home or facility that provides medical care — but only if you meet specific conditions. You must have been in a hospital for at least three consecutive days (not counting the day you leave), and you must enter the SNF within 30 days of leaving the hospital. The SNF must be Medicare-certified, which most are.
Part A covers up to 100 days per benefit period in a skilled nursing facility. You pay nothing for the first 20 days. From day 21 through day 100, you pay a coinsurance amount per day (this amount changes yearly). After 100 days, Part A stops paying and you pay the full cost. This coverage applies only to skilled care — physical therapy, occupational therapy, or nursing care — not to custodial care like help with bathing or dressing.
Hospice and home health services under Part A
Part A covers hospice care when a doctor certifies that you have a terminal illness and six months or less to live. Hospice focuses on comfort rather than cure and includes pain management, counseling, and symptom relief. You pay nothing for hospice care covered by Part A, though you may pay a small coinsurance for medications and medical equipment.
Part A also covers some home health services — skilled nursing, physical therapy, occupational therapy, and speech therapy — when ordered by a doctor and provided by a Medicare-certified home health agency. You must be homebound or have difficulty leaving home. Unlike skilled nursing facility care, there is no limit on the number of home health visits Part A will cover, as long as the care remains medically necessary.
How much you pay: deductibles and coinsurance
Part A has a deductible per benefit period, not per day. A benefit period begins the day you enter a hospital and ends 60 days after you leave the hospital without receiving any inpatient care. If you return to the hospital after that 60-day gap, a new benefit period starts and you owe a new deductible. The deductible amount changes yearly and covers your first hospital stay in that benefit period.
After you meet the deductible, you pay coinsurance (a fixed dollar amount per day) for hospital stays longer than 60 days. From days 61 to 90, you pay a coinsurance amount per day. From days 91 to 150, you pay a higher coinsurance amount per day. After 150 days, Part A stops paying and you pay the full cost. These amounts change yearly, so check your Part A documents or Medicare.gov for current figures.
Who gets Part A automatically and who must sign up
You receive Part A automatically at age 65 if you are a U.S. citizen or permanent resident and you have worked and paid Medicare taxes for at least 10 years (40 quarters). Social Security will enroll you in Part A automatically three months before your 65th birthday, even if you have not yet claimed Social Security benefits. You do not need to do anything — enrollment happens on its own.
If you did not work long enough to may have access to for free Part A, you can still buy it. The monthly premium depends on how many quarters of Medicare taxes you paid. If you are still working at age 65 and have health insurance through your job, you can delay Part A enrollment without penalty, but you must enroll within eight months of leaving that job or losing that coverage.
Part A and other types of Medicare coverage
Part A works alongside other Medicare parts but covers different services. Part B covers doctor visits, outpatient care, and preventive services — things Part A does not touch. Part D covers prescription drugs. Many people have all three parts, but you can have Part A alone if you do not need the others. Some people choose a Medicare Advantage plan (Part C) instead of Original Medicare (Parts A and B), which changes how all your coverage works.
If you have other insurance — from a current job, a spouse's job, or a private plan — that insurance may work with Part A. Tell your doctor and hospital about all your insurance so they bill in the correct order. Part A is always primary for hospital services if you have it, meaning it pays first.
Frequently Asked Questions
Do I have to take Part A when I turn 65?
Part A enrolls you automatically at 65 if you may have access to, but you can decline it. If you are still working and have health insurance through your job, you may want to delay Part A to avoid paying the premium. You have eight months after leaving that job to enroll without penalty.
What happens if I go to the hospital without Part A?
If you are not enrolled in Part A, Medicare will not pay for your hospital stay and you will owe the full bill. You can enroll in Part A during the general enrollment period (January 1 to March 31 each year), but coverage does not start until the month after you enroll.
Does Part A cover a hospital stay for mental health or substance use treatment?
Yes, Part A covers inpatient hospital stays for mental health and substance use treatment the same way it covers other hospital stays. You pay the deductible and coinsurance as you would for any other hospitalization. Some psychiatric hospitals have different rules, so ask the hospital about Part A coverage before admission.
Can I use Part A at any hospital?
Part A works at any hospital that accepts Medicare, which includes nearly all hospitals nationwide. If you go to a hospital that does not accept Medicare, Part A will not pay. Before a planned procedure, call the hospital to confirm it accepts Medicare.
What is the difference between Part A and a Medigap plan?
Part A is hospital insurance provided by Medicare. A Medigap plan is private insurance that helps pay the costs Part A does not cover — like deductibles and coinsurance. You can have both Part A and a Medigap plan at the same time.