Medicare Part A is the hospital insurance portion of Medicare. It covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care. Most people pay no monthly premium for Part A because they or a spouse paid Medicare taxes for at least 10 years while working. If you’re turning 65 or helping a parent navigate Medicare, Part A is likely the first piece you’ll encounter.
What Part A Covers
Part A pays for care when you’re formally admitted to a hospital as an inpatient. That includes your room, meals, nursing care, medications administered during your stay, and other hospital services. It also covers three other categories of care: skilled nursing facility stays (with conditions), hospice care for terminal illness, and certain home health services. Each of these categories comes with its own rules and cost-sharing, which are worth understanding before you need them.
Eligibility and Premiums
You qualify for premium-free Part A at age 65 if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters). You can also qualify before 65 if you’ve received Social Security disability benefits for 24 months, or if you have end-stage renal disease requiring regular dialysis or a kidney transplant.
If you don’t have enough work history for premium-free coverage, you can still buy into Part A. The monthly premium is either $311 or $565, depending on how long you or your spouse worked and paid Medicare taxes. People with 30 to 39 quarters of coverage pay the lower amount; those with fewer than 30 pay the higher one.
How Much You Pay for Hospital Stays
Part A uses a system of “benefit periods” rather than annual deductibles. A benefit period starts the day you’re admitted as an inpatient and ends when you’ve been out of a hospital or skilled nursing facility for 60 consecutive days. Each time a new benefit period begins, you pay the deductible again.
For 2025, the Part A deductible is $1,676 per benefit period. That single payment covers your first 60 days in the hospital. After that, costs climb:
- Days 1 through 60: $0 per day after paying the $1,676 deductible
- Days 61 through 90: $419 per day
- Days 91 through 150: $838 per day, drawn from a one-time pool of 60 “lifetime reserve days”
- Beyond 150 days: you pay all costs
Those lifetime reserve days are exactly what they sound like. You get 60 total for your entire life, not per benefit period. Once they’re used, they don’t reset. This is one reason many people purchase supplemental insurance (Medigap) to help cover extended hospital stays.
There’s also a lesser-known rule about blood. Part A doesn’t cover the first three pints of blood you receive in a benefit period. You can either pay the hospital’s charge for those pints or arrange to have the blood replaced through donation.
Skilled Nursing Facility Coverage
Part A covers stays in a skilled nursing facility, but only under specific conditions. You must first have a qualifying inpatient hospital stay of at least three consecutive days. The clock starts the day you’re admitted and does not include the day you’re discharged. After that qualifying stay, Part A covers up to 100 days in a skilled nursing facility per benefit period.
The cost-sharing for 2026 works like this: you pay nothing for the first 20 days after meeting the hospital deductible ($1,736 in 2026). Days 21 through 100 cost $217 per day. After day 100, Medicare stops covering skilled nursing facility care entirely for that benefit period.
This is where a common and costly misunderstanding comes into play. If you spent three nights in the hospital but were never formally admitted as an inpatient, those days don’t count toward the three-day requirement. That distinction between inpatient and observation status has real financial consequences.
Why Observation Status Matters
You can spend multiple nights in a hospital bed, receive round-the-clock care, and still not be considered an inpatient. If your doctor hasn’t written an order formally admitting you, you’re classified as an outpatient receiving “observation services,” even if you sleep there for days. This matters because observation time does not count toward the three-day inpatient stay required for skilled nursing facility coverage.
Hospitals are required to give you a written notice called a Medicare Outpatient Observation Notice (MOON) if you’ve been receiving observation services for more than 24 hours. This notice explains your status and warns you about how it could affect your costs both in the hospital and after discharge. Generally, an inpatient admission is appropriate when a doctor expects you’ll need two or more midnights of medically necessary hospital care, but the final decision rests with your doctor and the hospital.
If you or a family member is hospitalized and you’re unsure about the admission status, ask directly. The financial difference can be thousands of dollars, especially if a skilled nursing facility stay follows.
Hospice Care Under Part A
Part A covers hospice care when a doctor certifies that a patient is terminally ill with a life expectancy of six months or less. To qualify, you must accept palliative (comfort-focused) care instead of curative treatment for your terminal illness, and sign a statement choosing hospice care over other Medicare-covered treatments for that condition.
Hospice coverage is unusually comprehensive. It includes nursing care, pain management, counseling, and medical equipment related to the terminal illness. Prescription drugs for pain and symptom management cost no more than $5 per prescription. Medicare also covers short-term respite care, which gives primary caregivers a break. Respite stays can last up to five days at a time, and you pay roughly 5% of the Medicare-approved amount for that care.
There’s no hard cutoff at six months. If a patient is still terminally ill after the initial certification period, a hospice doctor or nurse practitioner can recertify eligibility after a face-to-face visit. Patients can continue receiving hospice care as long as they still qualify.
When and How to Enroll
Your Initial Enrollment Period for Medicare spans seven months: it begins three months before the month you turn 65, includes your birthday month, and extends three months after. If you qualify for premium-free Part A, there’s no penalty for enrolling during this window. Many people who are already receiving Social Security benefits are enrolled automatically.
If you need to pay a premium for Part A and miss your Initial Enrollment Period, you may face a late enrollment penalty that increases the longer you wait. The penalty lasts for as long as you have Part A coverage, so signing up on time saves money over the long run.
People who are still working and covered by an employer health plan at 65 have more flexibility. Special Enrollment Periods exist for these situations, allowing you to delay Part A enrollment without penalty. If your employer plan is ending soon and you’re approaching 65, check your specific enrollment window to avoid gaps in coverage.