Most people pay nothing for Medicare Part A. About 99% of beneficiaries qualify for premium-free coverage because they or a spouse paid Medicare taxes during at least 10 years of work. If you don’t meet that threshold, you’ll pay up to $518 per month in 2025. But the monthly premium is only part of the picture. Part A also comes with a deductible and coinsurance costs when you actually use hospital services.
Who Qualifies for Premium-Free Part A
You get Part A at no monthly cost if you’ve earned 40 or more quarters of coverage through payroll taxes, which works out to roughly 10 years of work. Your spouse’s work history counts too. If your spouse has 40 quarters, you qualify for premium-free Part A even if you never worked yourself. The same applies to divorced spouses, as long as the marriage lasted at least 10 years.
People who receive Social Security disability benefits also qualify for premium-free Part A after a 24-month waiting period, regardless of their work history. And anyone with end-stage renal disease or ALS (Lou Gehrig’s disease) can get Part A without meeting the standard work requirement.
Monthly Premiums If You Have to Pay
If you don’t have enough work credits for free Part A, the premium depends on how close you got. In 2025, the two tiers look like this:
- 30 to 39 quarters of coverage: $285 per month (a 45% reduction from the full price)
- Fewer than 30 quarters: $518 per month
These amounts increase slightly each year. For 2026, the reduced premium rises to $311 and the full premium to $565. There is no income-based adjustment for Part A premiums. Unlike Part B, where higher earners pay more, your Part A premium is the same regardless of income.
Late Enrollment Penalty
If you’re required to buy Part A and don’t sign up when you’re first eligible, a penalty gets added to your premium. The surcharge is 10% of the standard premium, and you’ll pay it for twice the number of years you went without coverage. So if you delayed enrollment by two years, you’d pay the higher rate for four years. This penalty applies only to people who must purchase Part A, not to those who get it for free.
Hospital Stay Costs Under Part A
Even with premium-free Part A, you’re responsible for costs when you’re admitted to the hospital. The structure is built around something called a benefit period, which starts the day you’re admitted as an inpatient and ends once you’ve gone 60 consecutive days without receiving inpatient hospital or skilled nursing care. Each benefit period triggers its own set of costs.
For 2025, the breakdown works like this:
- Days 1 through 60: You pay a $1,676 deductible for the benefit period. After that, Part A covers the full cost.
- Days 61 through 90: You pay $419 per day in coinsurance.
- Days 91 through 150: You pay $838 per day, drawing from a pool of 60 “lifetime reserve days.” Once those days are used, they don’t renew.
- Beyond 150 days: Part A stops covering you entirely.
Because a new benefit period starts after 60 days without inpatient care, you could end up paying the $1,676 deductible more than once in the same year. Someone hospitalized in January and again in June, for example, would owe the deductible both times. There’s no annual cap on how many benefit periods you can have.
Skilled Nursing Facility Costs
Part A covers care in a skilled nursing facility only if it follows a qualifying hospital stay of at least three consecutive days. When that condition is met, Part A pays the full cost for the first 20 days. From day 21 through day 100, you owe a daily coinsurance amount. After day 100, Part A coverage ends and you’re responsible for all costs. These skilled nursing costs fall within the same benefit period as your hospital stay.
Hospice and Home Health Costs
Hospice care under Part A is nearly free. If you receive care from a Medicare-approved hospice provider, you pay nothing for the core services: nursing care, medical equipment, counseling, and pain management. The two exceptions are a copayment of up to $5 per prescription for outpatient drugs related to pain and symptom control, and a 5% coinsurance charge for inpatient respite care (short stays designed to give your caregiver a break). That respite care copayment is capped at the Part A hospital deductible for the year.
Home health services covered under Part A also come with no coinsurance or copayment. If you need intermittent skilled nursing or therapy after a hospital stay, Part A picks up the full cost as long as you’re homebound and receiving care from a Medicare-certified agency.
How to Reduce Your Out-of-Pocket Costs
The deductible and coinsurance gaps in Part A are the main reason many people buy supplemental coverage. A Medigap plan (Medicare Supplement Insurance) can cover some or all of the hospital deductible and daily coinsurance charges. Medicare Advantage plans, which replace Original Medicare, often have different cost-sharing structures that include annual out-of-pocket maximums, something Original Medicare lacks entirely.
If your income is low enough, you may qualify for a Medicare Savings Program through your state Medicaid office. Depending on the program, it can pay your Part A premium, deductible, and coinsurance. The Qualified Medicare Beneficiary program, for instance, covers essentially all of your Medicare cost-sharing.