Medicare Part A: What It Covers, Costs, and How to Enroll
Medicare Part A is hospital insurance that covers inpatient care, skilled nursing facilities, hospice care, and some home health services.
Medicare Part A is hospital insurance that covers inpatient care, skilled nursing facilities, hospice care, and some home health services.
Medicare Part A, often called "hospital insurance," is one of the two parts of Original Medicare. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
About 99% of Medicare beneficiaries don't pay a monthly premium for Part A because they (or their spouse) paid Medicare taxes for at least 10 years (40 quarters) while working. Even without a premium, you'll still have out-of-pocket costs like deductibles and coinsurance when you receive care.
Part A covers inpatient and facility-based care—services that typically require an overnight stay at a hospital or intensive care at home. Think of the "four H's and an S": Hospital, Hospice, Home health, and Skilled nursing facility.
Inpatient Hospital Care
When you're formally admitted to a hospital as an inpatient, Part A covers:
• Semi-private room (private room if medically necessary)
• All meals during your stay
• General nursing care
• Medications administered by the hospital
• Lab tests, X-rays, and diagnostic services
• Operating and recovery room costs
• Medical supplies and equipment
• Inpatient rehabilitation services
• Inpatient mental health care (up to 190 days lifetime in a psychiatric hospital)
Part A covers various hospital types, including acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals.
Skilled Nursing Facility (SNF) Care
Part A covers short-term skilled nursing care in a Medicare-certified facility after a qualifying hospital stay. To qualify, you must have been an inpatient in a hospital for at least three consecutive days (not counting the discharge day) and be admitted to the SNF within 30 days of leaving the hospital.
SNF coverage includes:
• Semi-private room and meals
• Skilled nursing care
• Physical, occupational, and speech therapy
• Medical social services
• Medications, medical supplies, and equipment
Part A covers up to 100 days per benefit period in a skilled nursing facility. Days 1-20 are covered in full (after the Part A deductible). Days 21-100 require a daily coinsurance payment.
Hospice Care
Hospice provides comfort care (palliative care) for people who are terminally ill with a life expectancy of six months or less. To qualify for Medicare hospice coverage, your doctor and the hospice medical director must certify your terminal illness, and you must sign a statement choosing hospice care instead of curative treatment.
Hospice care includes:
• Doctor and nursing services
• Pain management and symptom control medications
• Medical equipment (hospital beds, wheelchairs, walkers)
• Medical supplies (bandages, catheters)
• Physical, occupational, and speech therapy
• Home health aide and homemaker services
• Grief and spiritual counseling for you and your family
• Short-term inpatient care (for pain/symptom management or respite care)
You pay nothing for hospice care, with minor exceptions: a $5 copay for outpatient prescription drugs and 5% coinsurance for inpatient respite care.
Home Health Care
Part A covers medically necessary home health services if you're homebound and need skilled nursing care or therapy. You must be under the care of a doctor, and a Medicare-certified home health agency must provide the services.
Covered home health services include:
• Intermittent skilled nursing care
• Physical, occupational, and speech therapy
• Medical social services
• Home health aide services (as part of skilled care)
• Some durable medical equipment
There's no deductible or coinsurance for home health care, and no prior hospital stay is required. Part A covers home health care if you're receiving skilled care following a hospital or SNF stay; otherwise, Part B covers it.
Blood
Medicare Part A covers blood you receive as an inpatient at a hospital or skilled nursing facility. However, you're responsible for the first 3 pints of blood you need unless you or someone else donates blood to replace it.
Part A has significant limitations. It does NOT cover:
Long-term care (custodial care): Part A covers skilled nursing care for a limited time after a hospital stay, but it does not cover extended stays in nursing homes or long-term care facilities for help with daily activities like bathing, dressing, or eating. You need long-term care insurance for that.
Outpatient services: Doctor visits, outpatient surgeries, lab tests as an outpatient, and most preventive care are covered by Part B, not Part A.
Prescription drugs: Medications you take at home are covered by Part D, not Part A. (Part A only covers drugs administered during an inpatient stay.)
Private rooms: Unless medically necessary, private hospital rooms are not covered.
Private duty nursing: Not covered even during an inpatient stay.
Personal items: Television, phone charges, toiletries, and other personal convenience items during a hospital stay are not covered.
Dental, vision, and hearing: Routine dental care, eye exams, glasses, and hearing aids are not covered by any part of Original Medicare.
Part A Premiums
About 99% of Medicare beneficiaries qualify for premium-free Part A because they or their spouse paid Medicare taxes for at least 40 quarters (10 years).
If you don't qualify for free Part A, you can still enroll but must pay a premium:
2026 Part A Premiums:
• 40+ quarters of work history: $0 per month
• 30-39 quarters of work history: $311 per month
• Fewer than 30 quarters: $565 per month
2025 Part A Premiums:
• 40+ quarters: $0 per month
• 30-39 quarters: $285 per month
• Fewer than 30 quarters: $518 per month
If you must pay a Part A premium, you'll also need to enroll in Part B and pay its premium ($202.90/month in 2026).
Part A Deductible
The Part A deductible is what you pay for each benefit period before Medicare starts covering your inpatient hospital costs:
• 2026: $1,736 per benefit period
• 2025: $1,676 per benefit period
What's a benefit period? A benefit period starts the day you're admitted to a hospital or SNF and ends when you haven't received inpatient care for 60 consecutive days. If you're admitted again after 60 days out, a new benefit period begins and you pay the deductible again.
Part A Coinsurance
Hospital stays (2026):
• Days 1-60: $0 (after meeting the deductible)
• Days 61-90: $434 per day
• Lifetime reserve days (91+): $868 per day (you have 60 lifetime reserve days total)
• Beyond lifetime reserve days: You pay 100% of costs
Skilled Nursing Facility (2026):
• Days 1-20: $0
• Days 21-100: $217 per day
• Beyond 100 days: You pay 100% of costs
Hospice:
• Most services: $0
• Prescription drugs for pain/symptoms: Up to $5 copay
• Inpatient respite care: 5% of the Medicare-approved amount
Home Health Care: $0 for covered services (you may pay 20% for durable medical equipment)
Automatic Enrollment
If you're already receiving Social Security or Railroad Retirement Board benefits when you turn 65, you'll be automatically enrolled in Medicare Parts A and B. Your Medicare card will arrive in the mail about 3 months before your 65th birthday.
Manual Enrollment
If you're not receiving Social Security or Railroad Retirement benefits, you'll need to sign up for yourself. You can enroll:
• Online at ssa.gov
• By calling Social Security at 1-800-772-1213
• At your local Social Security office
Initial Enrollment Period (IEP)
Your IEP is a 7-month window centered around your 65th birthday:
• 3 months before your birthday month
• Your birthday month
• 3 months after your birthday month
If you enroll within the 3 months before your birthday month, your coverage starts on the first day of that month. If you wait until later in your IEP, your coverage start date will be delayed.
Special Enrollment Period (SEP)
If you have group health coverage through your (or your spouse's) employer when you turn 65, you can delay Medicare enrollment without penalty. When that coverage ends, you get a Special Enrollment Period: 8 months to sign up for Part A and Part B without late enrollment penalties.
Late Enrollment Penalty
If you don't qualify for premium-free Part A and you delay enrollment beyond your IEP (without having other coverage), you may face a late enrollment penalty. The penalty is 10% added to your premium for each year you could have been enrolled but weren't.
Understanding whether you're an "inpatient" or "outpatient" is important because it determines which part of Medicare pays:
Inpatient (Part A): You're formally admitted to the hospital with a doctor's order. Part A covers the hospital stay.
Outpatient/Observation (Part B): You're receiving care in the hospital but haven't been formally admitted—even if you stay overnight. This is common with "observation status." Part B covers these services, and you pay 20% coinsurance.
Why this matters for skilled nursing: To qualify for Part A coverage at a skilled nursing facility, you need a 3-day inpatient hospital stay. Time spent as an outpatient or in observation status doesn't count toward those 3 days.
Always ask your doctor or hospital staff if you've been formally admitted as an inpatient. Hospitals must give you written notice (the Medicare Outpatient Observation Notice) if you've been in the hospital for more than 24 hours without being admitted.
Original Medicare has no annual out-of-pocket maximum, so costs can add up quickly—especially for extended hospital stays. Here are options to manage those costs:
Medigap (Medicare Supplement Insurance): Private insurance that helps pay Part A deductibles and coinsurance. Most Medigap plans cover the Part A deductible and hospital coinsurance in full.
Medicare Advantage (Part C): An alternative to Original Medicare offered by private insurers. These plans include everything covered by Parts A and B, often with additional benefits. They have annual out-of-pocket maximums ($9,250 in 2026) that limit your yearly spending.
Medicare Savings Programs: If you have limited income and resources, state programs may help pay your Medicare premiums, deductibles, and coinsurance.
Medicare Part A is foundational to your Medicare coverage, but understanding the costs, rules, and coverage details can be confusing. At Health Plans of NC, our licensed Medicare agents can help you understand:
• How Part A works with Part B and other coverage
• Whether you qualify for premium-free Part A
• How Medigap or Medicare Advantage can reduce your out-of-pocket costs
• Your enrollment options and deadlines
Contact us at 1-800-797-0327 for a free Medicare consultation. We're locally based in North Carolina and ready to help you navigate your Medicare options.
How much is the Medicare Part A premium in 2026?
Most people (99%) pay $0 for Part A because they or their spouse paid Medicare taxes for at least 10 years. If you don't qualify, the premium is $311/month with 30-39 quarters of work history, or $565/month with fewer than 30 quarters.
What is the Medicare Part A deductible for 2026?
The Part A deductible for 2026 is $1,736 per benefit period. You pay this amount each time you're admitted to the hospital (if it's been more than 60 days since your last inpatient stay). This deductible covers your share of costs for the first 60 days of hospital care.
Does Medicare Part A cover nursing home care?
Part A covers short-term skilled nursing facility care (up to 100 days) after a qualifying 3-day hospital stay. It does NOT cover long-term care or custodial care in nursing homes. For long-term care, you need separate long-term care insurance or Medicaid.
What's the difference between Part A and Part B?
Part A covers inpatient and facility-based care: hospital stays, skilled nursing facilities, hospice, and some home health care. Part B covers outpatient and medical services: doctor visits, preventive care, outpatient procedures, lab tests, and durable medical equipment. Together, they make up Original Medicare.
Do I need to sign up for Medicare Part A?
If you're receiving Social Security or Railroad Retirement benefits when you turn 65, you're automatically enrolled. Otherwise, you need to sign up during your Initial Enrollment Period (the 7 months around your 65th birthday). You can enroll online at ssa.gov, by phone, or at your local Social Security office.
Does Part A cover hospice care?
Yes. Medicare Part A covers hospice care if you're terminally ill with a life expectancy of 6 months or less, as certified by your doctor and the hospice medical director. You pay $0 for most hospice services, including doctor care, nursing, pain and symptom medications, medical equipment, and counseling.
