What Does Medicare Part A Cover?

Navigating Medicare can be complicated, especially when you’re trying to understand what each part actually covers. Whether you’re approaching age 65 or assisting a loved one, it’s important to start with the basics.

Medicare Part A, also known as hospital insurance, is a foundational part of Original Medicare. It’s designed to cover many hospital-related services and inpatient care. For many Americans, Medicare Part A is the first step toward building a more complete healthcare plan in retirement.

In this article, we’ll take a closer look at Medicare Part A – what it covers, who qualifies, how and when to enroll, and where its limits lie.

We’ll also explore related topics like potential costs, late enrollment penalties, and whether you need supplemental coverage like a Medigap plan.

Let’s start by looking at what Medicare Part A covers and how it helps with your hospital-related healthcare needs.

#1. Inpatient Hospital Care

One of the most critical services covered by Medicare Part A is inpatient hospital care. This coverage kicks in when you are formally admitted to a Medicare-accepting hospital by a physician. It includes a wide range of crucial hospital services for your treatment and recovery.

The following hospital-related costs will be covered by Medicare when you are being treated as an inpatient:

• Basic hospital services and supplies
• Semi-private rooms in the hospital
• Meals while you’re in the hospital
• General nursing
• Medication that is required as part of your inpatient treatment

However, it’s important to understand that Medicare doesn’t cover everything. For example, private-duty nursing, personal care items like razors or slippers, and a private room (unless medically necessary) are not included.

Important to know: Your hospital stay must be deemed medically necessary by a doctor, and you must be admitted, not just kept under observation, to be eligible for Part A benefits. This distinction between inpatient and observation status can significantly impact your coverage and costs, so it’s essential to confirm your status when hospitalized.

#2. Skilled Nursing Facility (SNF) Care

After being discharged from a hospital, some patients require additional time to recover in a facility that offers more medical care than at home. This is where Medicare Part A’s skilled nursing facility coverage comes into play.

To qualify for this benefit, you must have had a qualifying inpatient hospital stay of at least three consecutive days. Once you meet that requirement, Part A can cover your care in a Medicare-certified skilled nursing facility.

This includes skilled nursing care, rehabilitation therapies (like physical, occupational, or speech therapy), meals, and certain medical supplies.

However, the coverage has limits. Medicare fully covers the first 20 days of care in a skilled nursing facility. From day 21 to day 100, you are responsible for a daily coinsurance fee. Beyond 100 days, you are responsible for all costs unless you have additional insurance.

It’s also important to note that Medicare does not cover long-term custodial care, meaning help with activities like bathing or dressing, if that is the only care you need.

#3. Home Health Care

Medicare Part A can also help when your recovery occurs at home, provided specific conditions are met. Home health care is ideal for those who are homebound and need part-time skilled nursing care or therapy.

To qualify, a doctor must certify that you are homebound and need skilled services, such as nursing care or therapy. You must also receive care from a Medicare-certified home health agency.

If you meet these requirements, Medicare Part A may cover services including:

• Intermittent or part-time skilled nursing care
• Physical or occupational therapy
• Speech-language pathology services
• Medical social services
• Intermittent or part-time home health services from a home health aide
• Some medical equipment

This coverage allows patients to recover in the comfort of their own homes while still receiving essential medical attention. It’s a valuable benefit, especially for those who face challenges traveling to and from medical facilities.

However, it does not include 24-hour care, meal delivery, or personal care assistance when that’s the only support needed.

Generally, the home health agency that provides your home health care services will coordinate the services you receive based on your doctor’s orders. Long-term care is not usually included; instead, home health services are typically received and covered by Medicare on a short-term basis.

#4. Hospice Care

Hospice care is another vital service covered under Medicare Part A. This type of care is focused on comfort and quality of life for patients who are facing a terminal illness and are no longer seeking curative treatment.

To qualify for hospice coverage, a doctor must certify that you have a terminal condition with a life expectancy of six months or less if the illness runs its normal course. You must accept palliative care, which is care that is designed to keep you comfortable, instead of seeking care to cure your illness. You also must be willing to sign a statement that states that you choose hospice care over other types of Medicare-covered care that would be provided to cure your illness and any related conditions. Medicare Part A then covers a comprehensive set of hospice services, including pain management, symptom relief, medications, medical equipment like hospital beds and wheelchairs, and counseling services for the patient and family.

Hospice care can be provided at home, in a hospice center, or a facility like a nursing home if necessary. Inpatient respite care is also available to give family caregivers a break.

If you are given a prescription or other medication for symptom control or pain relief while at home, you may have to pay a copayment of no more than $5 per medication. In some rare cases, Medicare does not cover medications; if so, your hospice provider can check to see if your Medicare Part D prescription drug plan covers the medication.

Unlike many other parts of Medicare, hospice coverage is not focused on recovery but on making patients as comfortable as possible during the final stages of life.

#5. Inpatient Mental Health Services

Mental health is an important aspect of overall well-being, and Medicare Part A also extends its coverage to inpatient psychiatric care. If you or a loved one needs treatment in a psychiatric hospital or a psychiatric unit of a general hospital, Part A helps cover the associated costs.

This coverage includes the same benefits as general hospital care, such as room, meals, nursing care, and medications related to mental health treatment.

However, there are specific limitations. If you are admitted to a specialized psychiatric hospital, Medicare imposes a lifetime limit of 190 days. Once you reach that limit, you cannot receive further inpatient mental health coverage from Part A in that type of facility.

This is an area where additional coverage or planning may be necessary, especially for individuals who require long-term or recurring psychiatric treatment.

Medicare Part A: Costs and Coverage Limits

While many people refer to Medicare Part A as “premium-free,” that’s only true for individuals who have worked and paid Medicare taxes for at least 10 years (or 40 quarters).

If you don’t meet the 40-quarter requirement, you’ll have to pay a monthly premium.

In 2025, the standard premiums are:

• $285 per month if you have 30–39 quarters of Medicare-covered employment
• $518 per month if you have fewer than 30 quarters

These amounts may change each year based on the Centers for Medicare & Medicaid Services (CMS) adjustments.

To check if you qualify for premium-free Part A, review your Social Security work record, call Medicare, or log into your My Social Security account at ssa.gov.

In addition to potential premiums, there are other out-of-pocket costs. For instance, in 2025, beneficiaries face an inpatient hospital deductible of more than $1,600 per benefit period.

There are also coinsurance amounts for longer hospital or SNF stays. After 60 days in the hospital, you begin paying daily coinsurance, and after 90 days, you begin using lifetime reserve days, which are limited to 60 over your lifetime.

Understanding these costs is essential for effective financial planning, especially if managing chronic conditions or foreseeing multiple hospitalizations.

Who Qualifies for Medicare Part A?

Most people are automatically eligible for Medicare Part A at age 65 if they’re already collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board.

Some people qualify for Part A before they turn 65, like many people on Social Security Disability.

You may qualify for Medicare Part A before 65 if you have:

• A disability
• End-stage renal disease (ESRD)
• Amyotrophic lateral sclerosis (ALS)

You must be either a United States citizen or a legal permanent resident of at least five continuous years to be eligible to sign up for Medicare Part A.

Typically, workers who pay into the Social Security system and paid their Medicare taxes during their working years do not have to pay a premium. However, to be eligible for Medicare Part A without a premium, you must be entitled to these benefits because of funds that you paid in or that your spouse, parent, or child paid in during their working years.

If you are eligible for premium-free Part A, you can enroll anytime after becoming eligible for coverage. If you must pay a premium for Part A or if you want to sign up for Part B (which everyone has to pay a premium for), then you must sign up during one of these periods:

• Initial enrollment period
• General enrollment period
• Special enrollment period

If you need to enroll in Medicare Part A, visit Medicare.gov to learn more or call them directly at 1-800-772-1213 (TTY users 1-800-0778), Monday through Friday, from 7 AM to 7 PM.

Let’s talk in detail a little more about the Medicare Part A enrollment periods.

Medicare Part A Enrollment Periods

Signing up for Medicare Part A at the right time is super important to keep your healthcare coverage smooth and avoid late penalties. Understanding the different enrollment periods can help you figure out the best plan for your situation.

Most people already receiving Social Security or RRB benefits when they turn 65 are automatically enrolled in Medicare Part A. You’ll receive your Medicare card in the mail about three months before your 65th birthday. In this case, no action is needed unless you plan to delay Part B.

Outside of automatic enrollment, here’s a quick rundown of the key enrollment periods for Medicare Part A.

#1. Initial Enrollment Period (IEP) The Initial Enrollment Period is a 7-month window that begins three months before your 65th birthday, includes the month of your birthday, and extends three months after. For example, if your birthday is in July, your IEP runs from April 1 to October 31. Enrolling during the three months before your birthday ensures that your coverage begins on the first day of your birthday month (unless your birthday is on the first day of the month, in which case your coverage begins the month before). If you’re already receiving Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be automatically enrolled in Part A (and Part B) without action.

#2. General Enrollment Period (GEP) If you miss your Initial Enrollment Period, you can sign up during the General Enrollment Period, which runs from January 1 to March 31 each year. However, coverage will not begin until July 1 of that year, and you may be subject to late enrollment penalties, especially if you don’t qualify for premium-free Part A. This option is often used by those who didn’t enroll when first eligible and didn’t have qualifying coverage through an employer or other source.

#3. Special Enrollment Period (SEP) The Special Enrollment Period is available to individuals who delayed Medicare enrollment because they had group health insurance through an employer (theirs or a spouse’s). Once that employment or coverage ends, you have an 8-month window to enroll in Medicare Part A (and/or Part B) without penalty. Unlike the IEP, this period does not depend on your age, but on when your employer-based coverage ends. It’s important to note that COBRA and retiree health coverage do not count as “active employment” for the purposes of delaying Medicare without a penalty.

Avoiding Late Enrollment Penalties for Medicare Part A

While many people qualify for premium-free Medicare Part A, not everyone does. If you or your spouse haven’t worked and paid Medicare taxes for at least 10 years (or 40 quarters), you’ll have to pay a monthly premium to receive Part A coverage.

In that case, it’s important to enroll on time, because delaying enrollment without a valid reason can lead to financial penalties that last for years.

The late enrollment penalty for Medicare Part A applies only to people who must pay a premium. If you’re eligible for premium-free Part A, there’s no penalty for enrolling later. That said, it’s still a good idea to enroll as soon as you’re eligible to avoid gaps in coverage from other parts of Medicare.

Medicare will apply a late enrollment penalty for those needing to pay a premium and delaying enrollment without creditable coverage through an employer.

How the Penalty Works

The penalty adds 10 percent to your monthly Part A premium and is charged for twice the number of years you delayed enrollment.

For example, if you waited two years to sign up after becoming eligible, you would pay the higher premium for four years.

So if your standard Part A premium were $300 per month, you’d instead pay $330 per month during the penalty period, adding up to more than $1,400 in extra costs.

Pro tip: It’s a good idea to start planning for Medicare about 6 to 9 months before your 65th birthday, especially if you’re still working or have coverage through a spouse. Knowing which enrollment period applies to your situation will help you avoid gaps in coverage or unexpected costs.

Common Misunderstandings

Many people mistakenly believe they can delay Medicare enrollment if they have COBRA, retiree health plans, or Veterans Affairs benefits. However, none of these options count as active employment-based coverage to avoid penalties.

Only group health insurance from active employment – yours or your spouse’s – allows you to postpone Medicare enrollment without a late fee. Once that employer coverage ends, you have eight months to enroll before a penalty kicks in.

In a nutshell: If you’re required to pay for Medicare Part A, delaying enrollment can result in a long-lasting penalty that significantly increases your out-of-pocket costs. By understanding your enrollment periods and acting early, you can avoid unnecessary expenses and ensure you’re covered when needed.

Can You Have Medicare Part A Without Part B?

Yes, you can have Medicare Part A without enrolling in Part B, but whether you should or not depends on your circumstances.

Medicare Part A (hospital insurance) and Part B (medical insurance) together make up Original Medicare, but they are separate parts with separate enrollment and costs. Part A is often premium-free if you or your spouse worked and paid Medicare taxes for at least 10 years, while Part B requires a monthly premium ($185 in 2025).

If you’re still working at age 65 and have employer-sponsored health coverage, you might enroll in just Part A and delay Part B to avoid unnecessarily paying the monthly premium. This strategy is especially common when the employer has 20 or more employees, and your current insurance is considered creditable coverage – meaning it’s as good as Medicare’s.

In this case, you can delay Part B without penalty, and when your employer coverage ends, you’ll have a Special Enrollment Period to sign up for Part B.

Be aware: Delaying Part B without having creditable coverage (such as if you’re relying on COBRA, a retiree plan, or individual insurance) can lead to a late enrollment penalty. This penalty permanently increases your monthly premium by 10% for every 12-month period you were eligible but didn’t sign up. Also, if you only have Part A, you won’t be covered for doctor visits, preventive care, outpatient services, or durable medical equipment – all of which fall under Part B.

Do You Need Medicare Supplement Insurance with Part A?

Medicare Part A covers hospital-related care, such as inpatient hospital stays, skilled nursing facility care, some home health care, and hospice services.

However, it doesn’t cover everything, and there are cost-sharing requirements.

Medicare Supplement (Medigap) policies are sold by private insurance companies and are designed to help pay for the “gaps” in Original Medicare. That includes:

• Part A and Part B deductibles
• Coinsurance and copayments
• Extended hospital stays
• Blood transfusions
• Emergency care during foreign travel (some plans)

Note: Medigap does not work with Medicare Advantage plans – it’s only for people enrolled in Original Medicare (Part A and Part B).

You might want a Medigap policy if:

• You don’t want unpredictable out-of-pocket costs for hospital stays or medical care
• You plan to travel frequently (some Medigap plans cover international emergencies)
• You want simplicity and flexibility in choosing your providers (Medigap plans work with any provider who accepts Medicare)

Keep in mind: Medigap premiums are separate from your Medicare premiums, and they vary by plan, provider, and location.

Bottom Line

Medicare Part A is the cornerstone of hospital coverage for millions of older Americans and those with qualifying disabilities. It covers essential services like inpatient hospital care, skilled nursing facility stays, home health care, and hospice, providing critical support during some of life’s most serious health events.

Most people receive Part A without paying a premium, but understanding when to enroll, what’s covered, and what isn’t is just as important. Delaying enrollment without the right kind of health coverage can lead to costly penalties and gaps in care.

While Medicare Part A offers essential hospital coverage, it doesn’t completely protect against healthcare costs. A Medigap plan can give you predictable costs, added financial security, and peace of mind – especially when paired with Part B under Original Medicare.

Medigap is worth considering if you value flexibility in choosing providers and want to minimize surprise medical bills.

Whether you’re preparing to turn 65, helping a loved one navigate their options, or planning your retirement health strategy, getting informed about Medicare Part A is a smart first step. It lays the groundwork for the rest of your Medicare decisions and ensures you’re protected when it matters most.

Need Some Help?

We’re here to help you understand your options and guide you through choosing the right path on your Medicare journey.

We work with some of the country’s top-rated carriers if you’re considering Medigap. Check out our list of the top Medigap providers or explore the plans further with our Medigap Comparison Chart.

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