Understanding Medicare Part A

Medicare Hospital Insurance Benefits

Medicare has four parts, or programs, that provide coverage for different health-related services. Understanding how Medicare works may help you choose the Medicare options that best fit your needs.

Medicare Part A, also known as the Hospital Insurance program, helps cover the costs of:

Doctor consulting her patient
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Eligibility

If you are 65 or older, and have been legally present in the U.S. for at least five years, you are automatically eligible for Medicare Part A. And if you or your spouse worked at least 10 years in a job where you paid Medicare taxes (part of the FICA taxes), you'll receive Medicare Part A without having to pay any premiums.

Your Medicare Part A coverage starts on the first day of the month you turn 65, as long as you apply for coverage before that month. If you're already receiving Social Security retirement benefits or Railroad Retirement Board benefits, you'll be automatically enrolled in Medicare as of the month you turn 65, without having to manually enroll. In that case, you should receive your Medicare card in the mail three months before your 65th birthday.

If you are under 65, you are eligible to receive Part A benefits under the following circumstances:

  • You have been receiving Social Security Disability Insurance for more than two years. You should get your Medicare card in the mail prior to your 25th month of disability.
  • You have permanent kidney failure (end-stage renal disease, or ESRD) requiring ongoing dialysis or a kidney transplant. Special rules apply for people with ESRD, and the coverage start date depends in part on whether you enroll in a home dialysis training program.
  • You have been diagnosed with amyotrophic lateral sclerosis (Lou Gehrig’s disease). If you have ALS, you get Part A the month your disability benefits begin. And although there used to be a 5-month waiting period before disability benefits would begin for a person with ALS, that is no longer the case.

Premiums

If you are eligible for Medicare, you will not have to pay a monthly premium for Part A if you or your spouse worked and paid Medicare payroll taxes for at least 10 years.

If you and your spouse did not work or did not pay enough Medicare payroll taxes, you may not be eligible for premium-free Part A. However, you may be able to purchase Part A by paying a monthly premium, which is up to $499 in 2022 (the premium is lower, at $274/month, if you have at least 7.5 years of work history but less than a full 10 years/40 quarters). You should contact your local Social Security office up to three months before your 65th birthday to sign up.

If you choose to buy Medicare Part A, you also have the opportunity to enroll in Medicare Part B, which has a premium for all enrollees (in most cases, it's $170.10/month in 2022).

If your income is limited and you cannot afford the monthly premiums for Part A and/or Part B, your state may have a program to help. For information, view the brochure "Get Help With Your Medicare Costs" or visit the State Health Insurance Assistance Program (SHIP) site for information about free counseling in your state.

What Medicare Part A Covers

Hospital Stays

Covered services include a semi-private room, meals, general nursing care, medications, and other hospital services and supplies. Medicare does not cover private-duty nursing, the cost of a telephone or television in your hospital room, personal care items such as toiletries, or a private room unless it is necessary for your treatment.

Medicare does have some limits on hospital coverage. And you will have to pay a fairly modest portion of the cost of your care. But those out-of-pocket costs can be covered in part or in full by supplemental coverage obtained from an employer's plan, Medicaid, or a Medigap plan.

Medicare Part A differs from most commercial health insurance plans in that the deductible is based on a benefit period, rather than the calendar year. So depending on how much treatment you need and how it's spread out through the year, it's possible that you may have to pay the deductible more than once in a year.

But it's also possible to only have one deductible even when you have a hospitalization that spans two calendar years. (In that scenario, with most commercial insurance plans, you'd pay two deductibles.)

For each benefit period in 2022 you pay:

  • A total deductible of $1,556 for a hospital stay of 1-60 days
  • $389 per day for days 61-90 of a hospital stay
  • $778 per day for days 91-150 of a hospital stay (this coverage is known as lifetime reserve days; you have a maximum of 60 of these over your lifetime)
  • All costs for each day in the hospital once your lifetime reserve days are used up—unless you have a Medigap plan that pays for additional hospital coverage

Additionally, inpatient mental health care in a psychiatric hospital is limited to 190 days for your lifetime. There is no limit for mental health care in a general hospital.

A benefit period begins the day you go into a hospital or skilled nursing facility (SNF) and ends when you have not received any inpatient care in the hospital or SNF for 60 days in a row. You will have to pay the inpatient deductible for every benefit period.

Medicare Part A does not have a cap on out-of-pocket costs. So although it's rare for a hospitalization to continue for so long that the person uses up their benefits, it is possible. In that case, out-of-pocket costs can be unlimited unless a person has supplemental coverage.

Medicare Advantage plans do have caps on out-of-pocket costs, for the services that would otherwise be covered under Medicare Part A and Part B (but there is no cap on out-of-pocket costs for Medicare Part D (prescriptions), even if the coverage is provided through an Advantage plan.

Skilled Nursing Facility

Covered services include a semi-private room, meals, skilled nursing and rehabilitative services, and related supplies. Your stay in a SNF will be covered by Original Medicare only after a three-day minimum inpatient hospital stay for a related illness or injury. (Medicare Advantage plans have the option to waive the three-day hospital stay requirement.)

For example, if you were hospitalized for a stroke for one week, a skilled nursing facility stay for rehabilitation would be covered. But if you were only hospitalized for two days, your Original Medicare would not cover a subsequent skilled nursing facility stay. And if your hospitalization was classified as observation instead of inpatient care, you would not qualify for skilled nursing facility care after leaving the hospital.

You have no costs for the first 20 days in the SNF, but you will then have to pay (in 2022) $194.50 for days 21 through 100, and all costs for each day after day 100. These apply to each benefit period.

Home Health Services

To receive coverage of home health services from Medicare, you must be homebound (meaning that leaving home is a major effort), your healthcare provider must order your care, and the services must be provided by a Medicare-certified home health agency.

Coverage for home health care includes only medically necessary, part-time services such as skilled nursing care, a home health aide, physical or occupational therapy, speech-language pathology, and medical social services. It also includes durable medical equipment (such as wheelchairs, hospital beds, walkers, and oxygen) and medical supplies for use at home.

Custodial care and assistance with activities of daily living (like bathing, dressing, and eating) are not covered by Medicare unless they're performed in conjunction with medically-necessary skilled care.

You will have no costs related to the actual services provided in your home. However, you will have to pay a coinsurance of 20% of the Medicare-approved amount for any durable equipment your healthcare provider orders (in addition to your Part B deductible, if you haven't yet met it during the year; durable medical equipment is covered under Medicare Part B).

Hospice Care

Hospice care is for people with a terminal illness who are expected to live six months or less. Coverage includes medication for relief of pain and control of other symptoms; medical, nursing, and social services; and grief counseling. The services must be provided by a Medicare-approved hospice program.

Medicare also will cover inpatient respite care, which is care you get so that your usual caregiver can rest. Medicare will continue to cover your hospice care as long as your hospice physician or the medical director of the hospice recertifies that you are terminally ill.

Although there is no cost for hospice services, you will have a copayment of up to $5.00 for each outpatient prescription and you will be charged 5% of the Medicare-approved amount for inpatient respite care.

Should You Enroll in a Medigap Plan? Or a Medicare Advantage Plan?

While Medicare Part A will most likely pay for most of your hospital and skilled nursing facility expenses, you still will have some out-of-pocket costs. So, you may want to consider a Medigap plan to help pay your out-of-pocket costs such as hospital deductibles, coinsurance charges, and copayments.

If you enroll in a Medicare Advantage plan, you'll have coverage for everything that's covered under Part A, but your costs will be quite different from the standard Part A structure. Your Medicare Advantage plan will set its own cost-sharing rules, including deductibles, copayments, and out-of-pocket limits. Medigap plans cannot be used in conjunction with Medicare Advantage plans, however, so you'll generally be responsible for your own out-of-pocket costs if you have a Medicare Advantage plan.

Summary

Medicare Part A covers inpatient medical care. For most Medicare beneficiaries, Medicare Part A has no monthly premium. There's a deductible that's charged for each benefit period, and it covers up to 60 days in the hospital for that benefit period. Depending on the circumstances, Part A also covers skilled nursing facility care, home health care, and hospice care.

A Word From Verywell

If you're enrolled in Medicare, you likely receive Medicare Part A with no monthly premium; most people qualify for this due to their work history. Medicare Part A will provide you with solid coverage for inpatient hospital care, although it's not sufficient to be your only coverage. You'll also need to enroll in Part B (which has a monthly premium), in order to have coverage for outpatient care.

And since Medicare Part A and Part B have no cap on out-of-pocket costs, you'll also want to consider supplemental Medigap coverage, if you don't have retiree or employer-sponsored supplemental coverage.

10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Medicare & Medicaid Services. Getting started with Medicare.

  2. Centers for Medicare & Medicaid Services. Sign up/change plans.

  3. Center for Medicare & Medicaid Services. Signing up for Medicare if you have ESRD.

  4. Les Turner ALS Foundation. ALS Disability Insurance Access Act Signed into Law. December 22, 2020.

  5. Centers for Medicare & Medicaid Services. Part A costs.

  6. Centers for Medicare & Medicaid Services. Part B costs.

  7. Centers for Medicare & Medicaid Services. Medicare costs at a glance.

  8. Centers for Medicare & Medicaid Services. Inpatient mental health care (inpatient).

  9. Centers for Medicare & Medicaid Services. Skilled nursing facility (SNF) care.

  10. Centers for Medicare & Medicaid Services. Home health services.

By Michael Bihari, MD
Michael Bihari, MD, is a board-certified pediatrician, health educator, and medical writer, and president emeritus of the Community Health Center of Cape Cod.