Medicare Part A

What is Medicare Part A

Medicare Part A is hospital insurance that helps pay for inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice, limited home health, and inpatient blood. Most people get it premium-free if they (or a spouse) paid Medicare taxes for about 10 years; otherwise a monthly premium applies. You pay a deductible per benefit period and daily coinsurance after certain day limits, and you’re generally eligible at 65+ or earlier with certain disabilities or End Stage Renal Disease (ESRD).

Table of Contents:

Medicare Part A Coverage

Medicare Part A Covers:

Inpatient hospital care (room, meals, nursing, drugs, and services)
Skilled nursing facility (SNF) care (after a 3-day inpatient hospital stay, limited days)
Hospice care for people with a terminal illness
Home health care (limited, medically necessary, usually after hospital)
Inpatient blood (generally after the first 3 pints per year)

Medicare Part A Does Not Cover:

Long-term custodial care (e.g., nursing homes for daily living help)
Private-duty nursing
Private room costs (unless medically necessary)
Personal items (TV, phone, slippers, etc. in hospital)
First 3 pints of blood (unless donated or replaced)
Outpatient services (covered under Part B instead)

Medicare Part A Eligibility

Who is Eligible for Medicare Part A?

Age 65+ U.S. citizens or permanent residents (typically premium-free if you or a spouse worked and paid Medicare taxes long enough—generally 10 years).
Under 65 with disability (after 24 months of SSDI), or with ALS (automatic) or ESRD (special rules).

Medicare Part A Premium Cost

Premium-Free Part A

Most beneficiaries don’t pay a monthly premium for Part A.
To qualify, you (or a spouse) must have worked and paid Medicare payroll taxes for at least 40 quarters (10 years).
Premium-free eligibility applies even if you’re no longer working, as long as you’ve met the tax requirement.
Also available to people under 65 who qualify due to disability and meet the work-credit rules.

Premium Tiers for Those Without Enough Work Credits
If you don’t have the required work history, you can still buy Part A:

30–39 quarters of Medicare-covered work, your Medicare Part A Premium = $278/month (2025)
Less than 30 quarters of Medicare-covered work, your Medicare Part A Premium = $506/month (2025)

When It Applies:

The penalty only applies if you must pay a premium for Part A (meaning you don’t qualify for premium-free Part A through 40+ work quarters).
If you’re eligible for premium-free Part A, there’s no penalty for late enrollment.

How the Penalty Works:

If you don’t sign up when first eligible (during your Initial Enrollment Period) and you don’t qualify for a Special Enrollment Period, you may have to pay a penalty.
The penalty is an extra 10% of your monthly premium.
You’ll pay this for twice the number of years you delayed enrollment.

Example:

Let’s say you were eligible in 2022 but didn’t enroll until 2025 — a 3-year delay.
Your monthly Part A premium (for less than 30 quarters) in 2025 is $506.
Penalty = 10% × $506 = $50.60 extra per month.
You’d pay this penalty for 6 years (double the 3-year delay).

Medicare Part A Cost-Share

Medicare Part A cost share refers to the portion of hospital-related costs you pay when you use Part A benefits. Instead of monthly copays, Part A uses a per-benefit-period deductible and, after a set number of inpatient days, daily coinsurance that increases with longer stays. Similar cost-sharing rules apply to skilled nursing facility (SNF) care after a qualifying hospital stay, and there may be limited charges for hospice-related drugs and respite care (most hospice services are otherwise covered). Exact dollar amounts are set by Medicare and change each year, so it’s important to check the current rates for your coverage period.

Cost-Share for Inpatient Hospital Care

Inpatient hospitalization may include:

Semi-private room, meals, general nursing, and medications while inpatient.
Intensive Care Unit (ICU) services.
Operating room, lab tests, and inpatient rehabilitation.
Blood transfusions (after the first 3 pints per benefit period).

Hospital Stay	What You Pay
Deductible	$1,676 per benefit period
Days 1–60	$0 after deductible
Days 61–90	$419 per day coinsurance
Days 91–150 (Lifetime Reserve Days)	$838 per day coinsurance (max 60 days lifetime)
Beyond day 150	All costs

Cost-Share for Skilled Nursing Facility (SNF)

Covers medically necessary care following a hospital stay of at least 3 days:

Semi-private room and meals.
Skilled nursing care and therapy (physical, occupational, speech).
Medications and medical supplies.

SNF Stay	What You Pay
Days 1–20	$0/day
Days 21–100	$209.50/day coinsurance
After day 100	All costs

Cost-Share for Home Health Care

Part A may cover home health services if you are homebound and need skilled care on a part-time basis including:

Skilled nursing care.
Physical, occupational, or speech therapy.
Medical social services.
Certain medical supplies and DME.

You Pay: $0 for home health services; 20% coinsurance for DME.

Cost-Share for Hospice Care

For beneficiaries with a terminal illness (life expectancy ≤ 6 months) choosing comfort-focused care instead of curative treatment.

Services Covered:

Pain relief and symptom management.
Nursing and counseling services.
Certain home health aides and inpatient respite care.

You Pay:

$0 for hospice care services.
Up to $5 per prescription for pain management.
5% coinsurance for inpatient respite care.

Cost-Share for Blood Transfusion

You pay for the first 3 pints of blood per benefit period (unless donated to replace it). After that, Medicare pays 100%.

When to Enroll in Medicare Part A

You generally enroll in Medicare Part A and/or Part B during your Initial Enrollment Period (IEP)—a 7-month window spanning the 3 months before your 65th-birthday month, your birthday month, and 3 months after. If you enroll before your birthday month, coverage starts the first day of your birthday month (the month before if your birthday is on the 1st); if you enroll during or after, coverage starts the first day of the month after you enroll. If you’re still covered by active employer/union group health insurance (yours or your spouse’s), you may delay and later use a Special Enrollment Period (SEP)—an 8-month window that begins the month after employment or that coverage ends—to sign up without a late penalty. If you miss both IEP and SEP, you can enroll during the General Enrollment Period (GEP) (Jan 1–Mar 31 each year), with coverage beginning the first day of the month after you enroll and possible late-enrollment penalties. Premium-free Part A can be retroactive up to 6 months (not before you’re eligible); Part B is never retroactive.

Who qualifies:
Your Initial Enrollment Period (IEP) is your first chance to sign up for Medicare when you become eligible — usually when you turn 65 (or after 24 months of disability benefits).

When You Can Enroll:
Your IEP is a 7-month window that includes:

3 months before your 65th birthday month.
Your birthday month.
3 months after your birthday month.

During this period, you can enroll in:

Medicare Part A (Hospital Insurance).
Medicare Part B (Medical Insurance).
Medicare Advantage (Part C).
Prescription Drug Plan (Part D).

When Coverage Begins:

Enroll before your birthday month: Coverage starts the first day of your birthday month.
(If your birthday is on the 1st, coverage starts the month before.)
Enroll during your birthday month: Coverage starts the first day of the following month.
Enroll 1–3 months after your birthday month: Coverage starts the first day of the month after you enroll.

Example:
If your 65th birthday is July 20:

Enroll in April, May, or June → coverage begins July 1.
Enroll in July → coverage begins August 1.
Enroll in August → coverage begins September 1.
Enroll in September → coverage begins October 1.

Who qualifies:
You may use this SEP if you delayed enrolling in Medicare Part A and/or Part B because you (or your spouse) were covered under an employer or union group health plan.
When that coverage ends, you get a Special Enrollment Period to sign up without penalty.

When You Can Enroll:
The SEP lasts for 8 months starting the month after your employer or union coverage ends, or the month after your employment ends — whichever happens first.

You can choose to enroll in:

Medicare Part A (Hospital Insurance).
Medicare Part B (Medical Insurance).
And, if desired, a Medicare Advantage (Part C) or Prescription Drug Plan (Part D) once your Parts A & B are active.

When Coverage Begins:

Coverage generally starts the first day of the month after your plan or Social Security office receives your enrollment request.
You can request an earlier start date (retroactive up to 6 months) for Part A only — but not before you’re eligible for Medicare.
For Part B (and any Part C or D plans you choose), coverage always begins the first of the month after enrollment.

Example:

If your employer coverage ends April 30, your SEP runs from May 1 through December 31.
If you enroll in Part B in June, your Medicare coverage starts July 1.

What it is:
If you missed your IEP and don’t qualify for a SEP, you can sign up for Medicare Part A and/or Part B each year Jan 1 – Mar 31. Your coverage begins the 1st of the month after you enroll.

What you can do during GEP:

Enroll in Part A and/or Part B (late penalties may apply if you lacked creditable coverage).
Medicare.
After A/B are active, you may join Medicare Advantage (Part C) plan, or Prescription Drug Plan (Part D).

Plan coverage generally starts the 1st of the month after the plan gets your request.

Part D timing after GEP (important):
If you enroll in premium Part A and/or Part B during GEP, you get a Part D SEP that begins when you apply for A or B and lasts through the first 2 months of your A/B enrollment—so you can add Part D without waiting for AEP. (Coverage begins the 1st of the month after the Part D plan receives your request.)

Coverage start examples:

Enroll in Part B on Feb 10 → Part B starts Mar 1.
Submit an MA/PDP application on Mar 5 → plan starts Apr 1.

Penalty note:
Signing up during GEP can mean Part B (and/or Part A) late enrollment penalties if you didn’t have creditable coverage.

How to Enroll in Medicare Part A?

Automatic Enrollment in Medicare Part A

If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits when you turn 65, you’ll usually be automatically enrolled in both Part A and Part B.
Your Medicare card typically arrives 3 months before your 65th birthday.

Manual Enrollment in Medicare Part A

If you’re not receiving Social Security or RRB benefits, you must sign up through the Social Security Administration (SSA).

You can apply:

Online at SSA.gov
By phone at 1-800-772-1213
In person at a local Social Security office

When to Delay Enrollment into Medicare Part A

You may delay Part A if:

You’re still working.
Have employer coverage.
And want to keep contributing to an HSA.

In this case, you’ll enroll later during a Special Enrollment Period without penalty.

Employer Coverage Considerations:

If you or your spouse are still working and have employer coverage, Medicare and your employer plan coordinate payment.
If your employer has 20 or more employees: your employer plan is primary, and Part A is secondary.
If your employer has fewer than 20 employees: Medicare becomes primary, and the employer coverage is secondary.
If your employer coverage is creditable, you may delay Part A and/or B without penalty. However, many choose to enroll in free Part A for hospital coverage and keep their employer plan as primary.
Always check with your HR or benefits office to see how Medicare coordinates with your plan.

Health Savings Account (HSA) Impact:

If you’re contributing to an HSA, enrolling in Part A (even if premium-free) will stop your ability to keep making contributions.
Part A enrollment is often retroactive for up to 6 months, which can cause accidental tax penalties if you’ve contributed to your HSA during that time.

Medicare Part A Coverage

Medicare Part A Eligibility

Who is Eligible for Medicare Part A?

Medicare Part A Premium Cost

Cost Sharing (2025 Benefit Period)

Skilled Nursing Facility Cost Sharing (2025)

When to Enroll in Medicare Part A

How to Enroll in Medicare Part A?

When to Delay Enrollment into Medicare Part A

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