Medicare Part A is the portion of Medicare that covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people 65 and older get it premium-free if they or a spouse paid Medicare taxes for at least 10 years (40 work quarters). It’s often called “hospital insurance” because inpatient care is its primary function.
What Part A Covers
Part A pays for care in four main settings: inpatient hospitals, skilled nursing facilities, hospice programs, and (in limited cases) home health agencies. Within a hospital, it covers a semi-private room, meals, nursing care, medications administered during your stay, lab tests, surgeries, and intensive care. Critical access hospitals, which serve rural areas, are covered the same way.
Hospice care under Part A takes a team-based approach that addresses medical, physical, emotional, and spiritual needs for people with a terminal illness. You pay up to $5 per prescription for pain and symptom management drugs. If you need inpatient respite care (short-term care that gives your caregiver a break), you may owe 5% of the Medicare-approved amount, though your share can’t exceed the annual hospital deductible.
One important limit: inpatient psychiatric hospital care has a 190-day lifetime cap. That cap applies only to freestanding psychiatric hospitals, not to psychiatric units inside general hospitals.
How Benefit Periods Work
Part A doesn’t operate on a calendar year. Instead, it uses “benefit periods.” 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. Each new benefit period resets your coverage limits but also triggers a new deductible.
This means you could pay the inpatient deductible more than once in a single year if you’re hospitalized, discharged, stay out for 60 days, and then get readmitted. On the other hand, a single long hospitalization only triggers one deductible no matter how many months it lasts.
2025 and 2026 Costs
Part A has no monthly premium for most enrollees, but it does have a deductible and coinsurance that kick in during a hospital stay. Here’s what you owe in 2025 and what’s already been announced for 2026:
- Inpatient hospital deductible: $1,676 in 2025, rising to $1,736 in 2026. You pay this once per benefit period.
- Days 1 through 60: $0 after the deductible.
- Days 61 through 90: $419 per day in 2025, $434 in 2026.
- Lifetime reserve days: $838 per day in 2025, $868 in 2026. You get 60 of these over your entire lifetime, and once they’re used, they don’t renew.
If you don’t qualify for premium-free Part A, there are two price tiers. People with 30 to 39 work quarters pay a reduced monthly premium of $285 in 2025 ($311 in 2026). Those with fewer than 30 quarters pay the full premium: $518 per month in 2025, jumping to $565 in 2026.
Skilled Nursing Facility Coverage
Part A covers skilled nursing facility (SNF) stays, but only after a qualifying hospital stay of at least three consecutive inpatient days. The day you’re admitted counts, but the day you’re discharged does not. Time spent under observation or in the emergency department doesn’t count toward the three days either, even if you spend the night. This distinction catches many people off guard, because you can be physically in a hospital bed for days without technically being an “inpatient.”
Once you qualify, Part A covers up to 100 days per benefit period. The first 20 days cost you nothing beyond the hospital deductible you’ve already paid. Days 21 through 100 carry a daily coinsurance of $217 in 2026. After day 100, Medicare stops covering skilled nursing entirely for that benefit period.
Who Qualifies for Part A
The most common path is turning 65 with at least 40 quarters (10 years) of Medicare-taxed work on your own record, or on a spouse’s record. If you’re already receiving Social Security benefits at 65, you’ll be enrolled automatically.
You can also qualify before 65 in two situations. First, if you’ve been receiving Social Security or Railroad Retirement Board disability benefits for 24 months, you’re automatically enrolled in Part A. Government employees with disabilities who don’t qualify for those programs become eligible after 29 months. One major exception: people diagnosed with ALS (Lou Gehrig’s disease) get Part A immediately with no waiting period.
Second, people with end-stage renal disease who need regular dialysis or a kidney transplant are eligible for premium-free Part A, provided they or a spouse or parent has sufficient work history under Social Security or government employment.
Late Enrollment Penalties
If you have to buy Part A (because you don’t have enough work quarters for the premium-free version) and you don’t sign up when you’re first eligible, the monthly premium increases by 10%. You’ll pay that higher amount for twice the number of years you went without enrolling. So if you waited two years past your eligibility date, you’d pay the penalty surcharge for four years. This makes signing up on time particularly important for people who need to purchase Part A coverage.