Medicare Part A: Costs, Coverage & Eligibility

Medicare Part A is hospital insurance. It's one half of Original Medicare, and for most people it comes without a monthly premium.

But "premium-free" doesn't mean cost-free.

Part A still carries a hospital deductible, daily coinsurance for longer stays, and coverage limits that catch a lot of people off guard.

Here's what Part A actually covers, what it costs in 2026, and how to avoid enrollment mistakes that can lead to penalties or gaps in coverage.

What Is Medicare Part A?

Medicare Part A covers inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, home health services, and hospice care.

Most people get it premium-free because they (or a spouse) paid Medicare taxes for at least 10 years, or 40 work credits.

If you're already collecting Social Security or Railroad Retirement Board benefits when you turn 65, you'll typically be enrolled automatically.

If not, you'll need to sign up during one of Medicare's enrollment windows, covered below.

Medicare Part A Costs in 2026

Even with no premium, Part A isn't free at the point of care.

You pay an inpatient hospital deductible of $1,736 each time a new benefit period starts — not once a year, but every time you're readmitted after going 60 consecutive days without inpatient hospital or skilled nursing facility care.

We'll walk through how that works below.

Stay in the hospital past 60 days and daily coinsurance kicks in: $434/day for days 61–90, then $868/day if you dip into your 60 lifetime reserve days.

Once those are used, they don't come back.

Skilled nursing facility (SNF) care follows its own scale — $0/day for the first 20 days, then $217/day for days 21–100, as long as you still meet Medicare's requirements for skilled care.

Reaching day 100 isn't automatic; coverage can end earlier if your condition no longer requires skilled-level care.

What Does Medicare Part A Cover?

Inpatient Hospital Care

Once a doctor formally admits you to a Medicare-participating hospital, Part A covers your semi-private room, meals, general nursing, and medications given as part of your inpatient treatment.

It doesn't cover private-duty nursing, personal items like razors or slippers, or a private room unless it's medically necessary.

The distinction between "admitted" and "under observation" matters a lot here.

Observation status is billed under Part B, even if you stay overnight in a hospital bed — and it doesn't count toward the 3-day inpatient stay you need to qualify for SNF coverage.

Always ask your care team whether you've been formally admitted.

Skilled Nursing Facility Care

After a qualifying inpatient hospital stay of at least 3 consecutive days, Part A can cover care in a Medicare-certified skilled nursing facility — things like skilled nursing, physical/occupational/speech therapy, meals, and medical supplies.

Coverage lasts up to 100 days per benefit period, at $0/day for days 1–20 and $217/day for days 21–100, but only while you continue to need and receive skilled-level care.

It does not cover long-term custodial care (help with bathing, dressing, and similar daily needs) if that's all you require.

Home Health Care

If a doctor certifies that you're homebound and need part-time skilled nursing or therapy, Part A (along with Part B) can cover intermittent skilled nursing, physical/occupational therapy, speech-language pathology, medical social services, and part-time home health aide services, delivered through a Medicare-certified home health agency.

It does not cover 24-hour care, meal delivery, or personal care when that's the only service needed.

Hospice Care

Hospice care is available once a doctor certifies a terminal condition with a life expectancy of six months or less, and you choose palliative comfort care over curative treatment.

Covered services include pain and symptom management, medical equipment, and counseling for you and your family, in your home, a hospice facility, or a nursing home.

You may owe a copay of no more than $5 per prescription for outpatient pain and symptom management drugs.

Inpatient Mental Health Care

Part A covers inpatient psychiatric treatment the same way it covers general hospital care — room, meals, nursing, and related medications.

One key limit: care in a freestanding psychiatric hospital is capped at 190 days over your lifetime.

That cap doesn't apply to psychiatric units inside general hospitals.

What Medicare Part A Does Not Cover

Part A is hospital insurance, not comprehensive health coverage. It generally does not cover:

• Routine doctor visits and most outpatient care (that's Part B)
• Most prescription drugs you take at home (that's Part D)
• Routine dental care
• Routine vision care
• Hearing aids
• Long-term custodial care
• Most care received outside the United States

How the Medicare Part A Benefit Period Works

Part A uses "benefit periods," not calendar years, to track your deductible and coverage limits.

A benefit period starts the day you're admitted as an inpatient and ends once you've been out of a hospital or skilled nursing facility for 60 consecutive days.

There's no limit on how many benefit periods you can have in a year, or in your lifetime — and each new one comes with its own deductible.

Who Is Eligible for Medicare Part A?

Most people qualify for Part A at 65 through their own or a spouse's work history.

You may also qualify before 65 if you have a qualifying disability, end-stage renal disease (ESRD), or ALS.

To enroll, you generally need to be a U.S. citizen or a lawfully present permanent resident who has lived in the U.S. for at least 5 continuous years.

When Should You Enroll in Medicare Part A?

Initial Enrollment Period (IEP)

A 7-month window: 3 months before your 65th birthday month, your birthday month itself, and 3 months after.

If your birthday is in July, your IEP runs April 1 through October 31.

Enrolling in the 3 months before your birthday month typically gets your coverage started the first day of your birthday month (or the month before, if your birthday falls on the 1st).

Special Enrollment Period (SEP)

If you delayed enrollment because you (or your spouse) had group health coverage based on current employment, you get an 8-month SEP after that employment or coverage ends, whichever comes first — with no late penalty.

COBRA and retiree coverage do not extend this SEP.

Once active-employment coverage ends, the 8-month clock starts, regardless of whether you elect COBRA afterward.

General Enrollment Period (GEP)

If you miss both the IEP and you don't qualify for an SEP, you can enroll during the GEP, which runs January 1 through March 31 each year.

Coverage generally starts the month after you enroll — not automatically the following July.

You may still owe a late enrollment penalty if you needed to pay a Part A premium and didn't have qualifying coverage in the meantime.

Can You Delay Medicare Part A If You're Still Working?

If you're still working at 65 with group health coverage through an employer with 20 or more employees, you can generally delay Part B without penalty, since that coverage is considered primary based on current employment and Medicare Secondary Payer rules.

Most people don't delay Part A itself, since it's premium-free for most beneficiaries.

But if you're contributing to an HSA, that changes the calculus — see the next section.

Note: "creditable coverage" specifically refers to Part D-related drug coverage rules.

For delaying Part B while working, what matters is that your coverage is based on current employment, not the "creditable coverage" label.

When employer coverage ends, you'll have an 8-month SEP to enroll in Part B without a late penalty.

Delaying Part B without qualifying employer coverage — for example, relying on COBRA or a retiree plan — can trigger a permanent premium penalty of 10% for each 12-month period you were eligible but didn't enroll.

Medicare Part A and HSAs

If you're enrolled in a High-Deductible Health Plan and contributing to a Health Savings Account, enrolling in any part of Medicare — including premium-free Part A — stops your HSA contributions.

This catches people off guard because Part A enrollment can be retroactive.

If you sign up for Medicare after 65, premium-free Part A can be applied retroactively for up to 6 months (but never earlier than the month you first became eligible).

Contributions made to your HSA during that retroactive window can create a tax problem.

If you want to keep contributing to an HSA past 65, be especially careful about enrolling in Medicare or claiming Social Security benefits — claiming Social Security benefits can trigger automatic enrollment in premium-free Part A, and that enrollment may also be retroactive for up to 6 months.

Because of how these pieces interact, this is worth planning around 6–9 months in advance with your HR/benefits department or a tax professional.

Avoiding Late Enrollment Penalties

If you must pay a premium for Part A and don't sign up when first eligible (without a qualifying SEP), Medicare can add a 10% penalty to your monthly premium, charged for twice the number of years you delayed.

Delay 2 years, for example, and you'd pay the higher premium for 4 years.

If you're eligible for premium-free Part A, there's no penalty for enrolling later, though it's still wise to enroll on time to avoid coverage gaps.

Do You Need Medigap With Medicare Part A?

Depending on the plan, a Medicare Supplement (Medigap) policy can help pay some or all of Original Medicare's deductibles, coinsurance, and copayments.

Popular Plan G, for example, covers the Part A hospital deductible in full but does not cover the Part B deductible.

Newer Medigap plans generally can't cover the Part B deductible at all — that option (Plans C and F) is closed to anyone newly eligible for Medicare on or after January 1, 2020.

A Medigap policy can reduce some of the deductibles, coinsurance, and copayments you'd otherwise pay under Original Medicare.

Whether it makes sense depends on your health needs, budget, and the plans available where you live.

It only works alongside Original Medicare (Parts A and B) — not with Medicare Advantage.

See our Medicare Supplement Plan G guide or Plan N guide to compare options.

Part A vs. Part B, at a Glance

SNF coverage requires a qualifying 3-day inpatient hospital stay, and continues only while you meet Medicare's requirements for skilled care.

Want the full picture? See our Medicare Part B guide.

Bottom Line

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, home health, and hospice — the core of hospital-related coverage under Original Medicare.

Most people get it premium-free, but the deductible, coinsurance, and coverage limits still add up, and there's no annual out-of-pocket cap under Original Medicare.

Knowing your enrollment window, understanding how benefit periods work, and deciding whether Medigap fits your situation are the next steps toward a complete Medicare plan.

Frequently Asked Questions

Does Medicare Part A cover outpatient surgery done in a hospital?

No. Outpatient surgery, even performed in a hospital, is covered under Part B.

Part A only applies once you're formally admitted as an inpatient.

Will I lose Part A coverage if I go back to work?

No. Returning to work doesn't cancel Part A.

If you gain new employer coverage, you'll want to understand how it coordinates with Medicare to avoid gaps or unnecessary costs.

Does Part A cover care in a foreign hospital?

Generally no, with very limited exceptions (for example, certain emergencies near the Canadian or Mexican border).

Frequent travelers often look at supplemental coverage with foreign travel emergency benefits.

What happens to my Part A coverage if I move to a different state?

Part A is a federal program, so your coverage travels with you across all 50 states.

Just update your address with Social Security.

Does Part A cover dental work done in a hospital?

Only in narrow cases where dental care is medically necessary as part of a covered hospital procedure, such as jaw reconstruction after an accident.

Routine dental care, extractions, and dentures aren't covered by Part A or Part B.

Can I decline automatic enrollment in Part A?

If you're eligible for premium-free Part A, Medicare generally does not let you simply decline it while keeping your Social Security benefits — you can typically only drop Part A if you'd otherwise pay a premium for it.

This matters most for people who want to keep contributing to an HSA; talk to a benefits advisor before assuming you can opt out.

See the HSA section above.

What's the difference between a benefit period and a calendar year?

A benefit period is based on your hospital/SNF use, not the calendar.

It starts on admission and ends after 60 consecutive days out of a hospital or SNF.

You can have more than one benefit period — and pay more than one deductible — in a single year.

Is the Medicare Part A deductible annual?

No. Unlike many health insurance deductibles, the Part A deductible applies per benefit period, not per calendar year.

That means you could pay it more than once in the same year if separate hospital stays fall into different benefit periods.

Does Part A cover observation stays?

No. Observation is outpatient care under Part B, even overnight.

It also doesn't count toward the 3-day inpatient stay required for SNF coverage.