What Medicare Part A Covers and What You’ll Pay

Hospice care. These services are for terminally ill patients who choose to receive comfort care rather than treatment for their illness. This could include assistance from health aides, medication to manage pain, and respite care for up to five days to help family caregivers.

Limited nursing home care. If you’re recovering from an illness or injury and need 24-hour help with some medical care, such as recuperating from pneumonia or changing sterile dressings on wounds, you may be covered for up to 100 days of care.

Mental health care. The behavioral services you get when you’re admitted to a general or psychiatric hospital as an inpatient are paid for. As with other hospitalizations, the treatment you receive from a doctor while there falls under Part B.

A doctor must consider any of the care described as medically necessary. If you’re in a Medicare Advantage plan, you may have to go through prior authorization and use a nursing home that your plan has contracted with for services.

What Medicare Part A doesn’t cover

While Medicare’s scope is extensive, the government program doesn’t pay for some hospital services at all, such as:

• Extra nursing care that you hire
• Personal items like slipper socks or toothbrushes
• A private room unless medically necessary or the only option
• A television or telephone in your room
• Your room and board if you’re classified as an outpatient and not admitted to the hospital

Some hospitals will provide the personal items, phones and TVs at no charge to all patients. But if you don’t face a daily charge, you might have to pay for phone calls.

Additionally, you’ll have to pay for most care outside the United States and for long-term help with daily activities such as bathing, dressing, eating and walking, sometimes called custodial care.

But Part B picks up the tab for many doctor costs while you’re hospitalized, which may become an important distinction if you’re delaying Part B. The services of your surgeon and other physicians in the operating room fall in the same category, even though Part A generally covers your hospital costs.

If you haven’t been admitted as an inpatient, Medicare will treat your doctor and hospital services as if you were an outpatient, using Part B coverage rules, where you pay a 20 percent coinsurance after meeting the Part B deductible.

The costs you pay for Medicare Part A

Most people 65 and older pay no premiums for Part A because they’ve either worked 40 quarters and paid Medicare taxes or they qualify through their spouse. If you’re on Medicare earlier because of a disability, you also get premium-free Part A.

But if you’re among the relatively few older adults who aren’t eligible for zero-premium Part A, you can buy it, just like you buy a private insurance policy. You’ll also have to sign up for Part B, which has its own premiums, to do so.

If you’ve worked and paid Medicare taxes for 30 to 39 quarters, your Part A premium is $311 a month in 2026. Others eligible for Medicare but who have worked fewer quarters pay $565 a month in 2026.

Penalties. Anyone who can get Part A for free doesn’t have to sign up at age 65. But if you have to pay a premium, you may be penalized for not signing up during your initial enrollment period.

If you or your spouse are working and have health insurance from that employer, you won’t have to worry about a penalty because the government considers that equivalent coverage. You’re also exempt if you’re living abroad.

But if you’re not insured and don’t buy Part A when you’re first eligible, you could pay a late enrollment penalty of 10 percent a month for every month you go uncovered on top of your Part A premium. It will last for twice the number of years you could have bought Part A but didn’t.

Deductibles. If you’re on original Medicare, you’ll pay $1,736 in 2026 for each benefit period you’re hospitalized before your Medicare benefits kick in.

That’s one reason many people who choose original Medicare also opt to buy Medicare supplement insurance, better known as Medigap. The most popular plans cover that deductible and other hospital expenses.

If you choose Medicare Advantage, you still have to enroll in Part A and Part B, but the rules on deductibles for hospitalization vary by plan. And you may have to make copayments — a flat fee — for some of your days in the hospital.

Benefit periods. This concept is likely different from any other insurance plan you’ve had previously if you’re on original Medicare. Deductibles for other insurance are generally an annual amount.

A benefit period begins when you’re admitted to a hospital or a skilled nursing center as an inpatient and ends when you’ve been out of the hospital or skilled nursing center for 60 days in a row.

So you can have more than one benefit period in a calendar year. But you’ll also pay a single deductible if you have more than one hospital stay during a benefit period.

Coinsurance. This portion of costs you pay yourself after you have met your deductible is typically a percentage, such as 20 percent, of the charges. Some providers instead require a copay that often ends up at about the same amount as coinsurance.

Medigap plans generally cover this.

Medicare Advantage plans’ out-of-pocket spending limit, which includes copayments, coinsurance and deductibles for what would be covered under Part A and Part B but not premiums or drug costs, can’t exceed $9,250 for in-network care, and $13,900 total for covered in-network and out-of-network services in 2026. Some plans have lower limits, but because Medicare Advantage plan enrollees can’t use Medigap, you’ll have to pay these costs yourself.

Why inpatient status matters. Because the average hospital stay last year was fewer than five days, inpatient status is an important distinction to be vigilant about.

If you first came to the hospital in an ambulance and spent extensive time in the emergency room, that period does not count toward the three days. If a doctor decides you need to spend additional time at the hospital for observation but doesn’t give you inpatient status, it too won’t matter.

Counting the midnights of every day is an easy way to determine whether you’ve been hospitalized for long enough to receive Part A benefits in a rehabilitation center or nursing home afterward. Medicare doesn’t count the day you leave the hospital as a full day but will count your admission at, say, 8 p.m. on the first day as one full day.

Who qualifies for Medicare Part A?

If you’re age 65 and a U.S. citizen or permanent legal resident, better known as a green card holder, who has lived continuously in the U.S. for at least five years, you’re eligible for Medicare.

But because the law regarding Medicare eligibility of some legal immigrants changed in mid-2025, only a few groups specifically named in federal law — certain people from Cuba, Haiti or the small Pacific island nations of Marshall Islands, Micronesia and Palau — can qualify if they don’t have green cards.

If you’re younger than 65 and receive Social Security Disability Insurance (SSDI), you’ll be automatically enrolled in Part A and Part B 24 months after you became eligible for disability benefits. If you have amyotrophic lateral sclerosis (ALS) or kidney failure, you’ll get Medicare sooner.

When to sign up for Part A

If you’re on SSDI but haven’t yet qualified for Medicare or are receiving Social Security retirement benefits, both at least four months before your 65th birthday, you should receive your new Medicare card automatically about three months before your birthday month, four if your birthday is on the first of a month. You’ll be enrolled in both Part A and Part B without applying.

Everyone else has to sign up for themselves through the Social Security Administration (SSA), which is responsible for Medicare enrollment.

Initial enrollment period. A lot of people about to turn 65 sign up for Part A, even if they expect to continue working, because they don’t pay a premium. Part A works with your employer’s health insurance as an extra safety net, potentially paying for services that your present policy doesn’t cover if you’re hospitalized.

You can enroll at any time during your seven-month initial enrollment period that centers around your 65th birthday month.

If you sign up before the month you’re 65, coverage begins on the first day of your birthday month. If you apply during your birthday month or the other three months in your initial enrollment period, it will start the next month afterward.

Still working? If you qualify for premium-free Part A, you can sign up whenever you want after 65 without any penalties.

However, if you work for a small business with fewer than 20 employees, your company’s insurance likely becomes secondary when you turn 65. Double-check with your benefits department.

If you don’t sign up for Medicare Part A — and Part B — at 65, you could be stuck with surprise hospital bills even if you’re admitted as an inpatient. Your workplace insurance won’t step up to fill in the gaps.

If you have an HSA. Contributing to a health savings account (HSA) at work adds a new wrinkle to the idea of signing up for Part A at 65. You can’t save tax-free money in an HSA if you’re enrolled in any part of Medicare.

If you want to continue your contributions, delay Part A. Otherwise, you could face IRS penalties.

If you don’t, just make sure that you stop contributing before your Medicare effective date. That may mean telling your plan six months in advance about your intentions.

You can still have a health savings account after you enroll in Medicare. You can use it to pay any future Medicare bills, which is a good way to use that savings in retirement.

 

This story, originally published Oct. 16, 2023, has been updated with additional information about the general enrollment period and other details.