Most people pay nothing for Medicare Part A. If you’ve worked and paid Medicare taxes for at least 10 years (40 quarters), your Part A premium is $0. You still face out-of-pocket costs when you actually use hospital services, though, and those costs can add up quickly during a long stay.
Who Pays a Monthly Premium
Part A covers hospital stays, skilled nursing care, hospice, and some home health services. Whether you owe a monthly premium depends entirely on how long you or your spouse worked and paid into Medicare through payroll taxes.
If you have fewer than 30 work credits, you’ll pay the full premium. If you have between 30 and 39 credits, you pay a reduced rate. And if you’ve hit 40 credits, roughly 10 years of work, you pay nothing. The premium amounts adjust each year, so checking the current year’s rates on Medicare.gov gives you the exact number. People who must buy Part A and delay signing up face a penalty: premiums go up 10%, and you pay that surcharge for twice the number of years you went without coverage.
The Hospital Deductible
Even with premium-free Part A, every hospital admission starts with a deductible. In 2026, that deductible is $1,736 per benefit period. This isn’t an annual deductible like most private insurance. It resets every time a new “benefit period” begins.
A benefit period starts the day you’re admitted to a hospital and ends after you’ve been out of a hospital or skilled nursing facility for 60 consecutive days. If you’re discharged, stay home for two months, then get readmitted, you pay the full deductible again. There’s no limit on how many benefit periods you can have in a year, which means multiple hospitalizations in the same year could cost you the deductible several times over.
What You Pay During a Hospital Stay
For the first 60 days of a hospital stay within a single benefit period, you pay nothing beyond the deductible. After that, daily coinsurance kicks in and rises steeply.
- Days 1 through 60: $0 per day after you’ve paid the deductible.
- Days 61 through 90: $434 per day.
- Days 91 through 150: $868 per day, drawn from your 60 lifetime reserve days.
Those 60 lifetime reserve days are a one-time bank. Once you use them, they don’t renew. If you exhaust all 150 covered days, you’re responsible for the full cost of any additional hospital time. For context, the average hospital stay in the U.S. lasts about five days, so most people never come close to these limits. But a serious illness or complicated recovery can push well past 60 days, making supplemental insurance worth considering.
Skilled Nursing Facility Costs
Part A covers up to 100 days in a skilled nursing facility per benefit period, but only after a qualifying hospital stay of at least three days. The first 20 days are fully covered. Starting on day 21, you pay $209.50 per day in coinsurance (2025 rate). After day 100, Medicare stops paying entirely, and you’re on the hook for the full daily rate, which often runs $300 or more.
This is one of the biggest gaps in Part A coverage. Many people assume Medicare covers long nursing home stays, but it doesn’t. The 100-day limit applies to skilled care following a hospitalization, not custodial or long-term care.
Hospice and Psychiatric Coverage
Hospice care under Part A is unusually generous compared to other benefits. If you have a terminal illness with a life expectancy of six months or less and choose comfort care over curative treatment, Part A covers nearly everything: nursing, medical equipment, counseling, and pain management. You pay up to $5 per prescription for pain and symptom drugs. For inpatient respite care, which gives your caregiver a temporary break, you pay 5% of the Medicare-approved amount.
Psychiatric hospital care has a separate limit. Part A covers inpatient treatment in a psychiatric hospital for a maximum of 190 days over your entire lifetime. Psychiatric care in a general hospital follows the standard hospital rules instead, with no lifetime cap specific to mental health.
Help Paying Part A Costs
If you have limited income and need to buy Part A, or if the deductibles and coinsurance feel unmanageable, Medicare Savings Programs can help. The Qualified Medicare Beneficiary (QMB) program pays your Part A premiums, deductibles, and coinsurance. For 2026, you may qualify as an individual with monthly income up to $1,350 and resources up to $9,950, or as a married couple with income up to $1,824 and resources up to $14,910. Some states set higher limits than the federal floor, so it’s worth checking with your state Medicaid office even if you’re slightly above those numbers.
Medigap (Medicare Supplement) plans are another option. These private insurance policies are specifically designed to cover the gaps in Original Medicare, including the Part A deductible and hospital coinsurance. Premiums vary by plan and location, but for people worried about the cost of a long hospitalization, they can cap your exposure significantly.