Medicare Part A, often called hospital insurance, is the foundation of your Medicare coverage. Understanding how Part A works, what it costs, and what it covers can help you make informed decisions about your healthcare and avoid unexpected medical bills. This comprehensive guide walks you through everything you need to know about Medicare Part A for 2026.
What Is Medicare Part A?
Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Part A is premium-free for more than 99 percent of beneficiaries who have at least 40 quarters of Medicare-covered employment—that’s 10 years of work history where you or your spouse paid Medicare taxes.
Unlike Medicare Part B, which covers doctor visits and outpatient services, Part A focuses on care you receive when admitted to a hospital or certain medical facilities. It’s designed to protect you from the high costs of extended hospital stays and post-hospital recovery care.
🧠 Need a refresher? Check out our Guide to the Four Parts of Medicare!
What Does Medicare Part A Cover?
Medicare Part A provides coverage for several types of inpatient care:
Inpatient Hospital Care
Part A covers your hospital room, meals, nursing care, medications administered during your stay, medical supplies, and other hospital services when you’re admitted as an inpatient. This includes semi-private rooms, intensive care, and coronary care units. The coverage begins when a doctor formally admits you to the hospital—observation status doesn’t count as inpatient admission.
Skilled Nursing Facility Care
After a qualifying hospital stay of at least three days, Part A covers up to 100 days of skilled nursing facility care per benefit period. This isn’t long-term care or custodial care—it’s short-term, skilled care to help you recover from surgery or serious illness. You must enter the skilled nursing facility within 30 days of your hospital discharge to qualify for coverage.
Hospice Care
For beneficiaries with terminal illnesses, Part A covers hospice care including pain management, symptom control, medical equipment, medications related to the terminal illness, and support services. Hospice care can be provided at home, in a hospice facility, hospital, or nursing home.
Home Health Care
Part A covers limited home health services when you’re homebound and need intermittent skilled nursing care or therapy. This includes part-time nursing care, physical therapy, occupational therapy, and speech-language pathology services prescribed by your doctor.
What Medicare Part A Does NOT Cover
Understanding what Part A doesn’t cover is just as important as knowing what it does cover:
- Long-term care or custodial care (help with daily activities like bathing, dressing, and eating)
- Private-duty nursing
- Private room in a hospital (unless medically necessary)
- Television or telephone in your hospital room
- Personal comfort items
- Doctor services while you’re in the hospital (covered by Part B)
2026 Medicare Part A Costs: What You’ll Pay
Understanding your Part A costs helps you plan for healthcare expenses. Here’s a complete breakdown of 2026 Medicare Part A costs.
The Part A Premium: Who Pays and How Much
Medicare Part A is premium-free for more than 99 percent of beneficiaries. These individuals, or their spouse, have at least 40 quarters of Medicare-covered employment. If you or your spouse worked and paid Medicare taxes for at least 10 years, you don’t pay a monthly premium for Part A.
However, some people don’t qualify for premium-free Part A. If you have fewer than 40 quarters of work credits, you can purchase Part A coverage:
- 30-39 quarters of coverage: $311 per month in 2026 (up from $285 in 2025)
- Fewer than 30 quarters: $565 per month in 2026 (up from $518 in 2025)
Important: You must also enroll in Medicare Part B to purchase Part A if you don’t qualify for premium-free coverage.
The Part A Deductible for 2026
The Part A deductible will be $1,736 in 2026, an increase of $60 from 2025. This deductible applies per benefit period (explained in detail below), not per calendar year. You could potentially pay this deductible more than once in a single year if you have multiple benefit periods.
Daily Coinsurance Costs for Hospital Stays
After you pay the deductible, Part A covers your inpatient hospital costs for the first 60 days. If you stay longer, you’ll pay daily coinsurance:
- Days 1-60: $0 (after paying the $1,736 deductible)
- Days 61-90: $434 per day in 2026 (up from $419 in 2025)
- Days 91 and beyond (lifetime reserve days): $868 per day in 2026 (up from $838 in 2025)
Skilled Nursing Facility Coinsurance
For skilled nursing facility stays, Part A coverage works differently:
- Days 1-20: $0 (fully covered after deductible)
- Days 21-100: $217.00 per day in 2026 (up from $209.50 in 2025)
- Days 101 and beyond: You pay all costs
Understanding Medicare Benefit Periods: The Key to Part A Costs
The benefit period concept is crucial for understanding your Part A costs. Unlike most insurance that operates on a calendar year, Medicare Part A uses benefit periods to measure your use of hospital and skilled nursing facility services.
What Is a Benefit Period?
A benefit period begins the day you’re admitted as an inpatient in a hospital or skilled nursing facility. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a skilled nursing facility) for 60 days in a row.
Here’s what this means in practice:
- You pay the Part A deductible at the start of each benefit period
- There’s no limit to how many benefit periods you can have
- You could have multiple benefit periods in one calendar year
- Or a benefit period could span across calendar years
Benefit Period Examples
Example 1: One Benefit Period, Two Hospitalizations
Sarah is admitted to the hospital on March 1st for pneumonia and stays for 5 days. She pays the $1,736 Part A deductible. She’s discharged on March 6th and goes home to recover.
On April 20th—just 45 days after her discharge—Sarah develops complications and is readmitted to the hospital for 3 days. Because fewer than 60 days have passed since her last hospital stay, this is still the same benefit period. Sarah doesn’t pay another deductible. She’s now used 8 of her 60 covered days in this benefit period.
Example 2: Two Benefit Periods, Two Deductibles
James has hip replacement surgery on January 15th and stays in the hospital for 4 days. He pays the $1,736 deductible. After his discharge, he completes physical therapy at home and recovers well.
On August 30th—more than 7 months and well past 60 days since his surgery—James falls and breaks his wrist. He’s admitted to the hospital for 2 days. Because more than 60 days passed between hospitalizations, this starts a new benefit period. James must pay another $1,736 deductible for this hospitalization, even though both happened in the same calendar year.
Example 3: Extended Stay with Coinsurance
Margaret is admitted to the hospital on February 10th with a serious infection. She pays her $1,736 deductible. Her condition is severe, and she remains hospitalized for 75 days total.
Here’s what Margaret pays:
- Days 1-60: Just the $1,736 deductible (no additional daily costs)
- Days 61-75: $434 per day × 15 days = $6,510 in coinsurance
- Total out-of-pocket for Part A: $8,246
Lifetime Reserve Days: Your Emergency Bank of Coverage
Medicare Part A includes a special feature called lifetime reserve days. You have 60 lifetime reserve days that can be used after you’ve exhausted the standard 90 days of coverage in a benefit period. These 60 days are not renewable and may be used only once during a beneficiary’s lifetime.
How Lifetime Reserve Days Work
Think of lifetime reserve days as an emergency fund of hospital coverage:
- You get 60 lifetime reserve days total—not per benefit period
- Once used, they’re gone for your entire lifetime
- They can be applied across multiple hospitalizations
- You pay $868 per day for each lifetime reserve day in 2026
Example: Using Lifetime Reserve Days
Robert is hospitalized with severe heart complications and stays for 105 days within a single benefit period.
Here’s how his coverage breaks down:
- Days 1-60: $1,736 deductible only
- Days 61-90: $434/day × 30 days = $13,020
- Days 91-105: $868/day × 15 lifetime reserve days = $13,020
- Total: $27,776 out-of-pocket
Robert has now used 15 of his 60 lifetime reserve days, leaving him with 45 reserve days remaining for his entire life.
Hospital vs. Observation Status: A Critical Distinction
One of the most confusing aspects of Medicare Part A is the difference between inpatient admission and observation status. This distinction can significantly impact your costs and coverage.
Inpatient Status
When a doctor formally admits you to the hospital as an inpatient, Part A covers your stay (after the deductible). Your days in the hospital count toward your benefit period, and your stay can qualify you for skilled nursing facility coverage afterward.
Observation Status
Observation status means you’re in the hospital for evaluation, but you haven’t been formally admitted as an inpatient. In observation status:
- Part A doesn’t cover your stay
- Part B covers observation services (you pay 20% coinsurance)
- These days don’t count toward the 3-day hospital stay requirement for skilled nursing coverage
- You may pay more out-of-pocket for the same services
Tip: Always ask your doctor about your admission status. If you’re unsure, request to speak with a patient advocate or social worker at the hospital.
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Skilled Nursing Facility Coverage: Important Requirements
Medicare Part A covers skilled nursing facility care, but there are strict requirements you must meet:
The Three-Day Hospital Stay Rule
You must have a qualifying hospital stay of at least three consecutive days as an inpatient (not observation status) before Medicare will cover skilled nursing facility care. The three days don’t include the day you’re discharged.
The 30-Day Transfer Window
You must enter the skilled nursing facility within 30 days of your hospital discharge. If more than 30 days pass, Medicare won’t cover your skilled nursing care.
Skilled Care Requirement
You must need daily skilled nursing or therapy services that can only be provided by skilled personnel. Custodial care (help with bathing, dressing, eating) alone doesn’t qualify for Medicare coverage.
Example: Qualifying for Skilled Nursing Coverage
Linda has a stroke and is admitted to the hospital on Monday. She’s treated as an inpatient for four days (Monday through Thursday) and is discharged Friday morning. Her doctor recommends skilled nursing care for physical and occupational therapy.
Linda enters a Medicare-certified skilled nursing facility the following Monday (10 days after her hospital discharge). Because she:
- Had at least a 3-day inpatient hospital stay
- Entered the SNF within 30 days of discharge
- Needs skilled therapy services
Linda qualifies for Medicare Part A skilled nursing coverage. She pays nothing for the first 20 days, then $217 per day for days 21-100.
How to Enroll in Medicare Part A
Most people are automatically enrolled in Medicare Part A when they turn 65 if they’re already receiving Social Security or Railroad Retirement Board benefits. You’ll receive your Medicare card in the mail about three months before your 65th birthday.
If You’re Not Automatically Enrolled
If you’re not receiving Social Security benefits, you’ll need to sign up for Medicare during your Initial Enrollment Period, which begins three months before you turn 65 and ends three months after your birthday month.
You can enroll:
- Online at ssa.gov
- By phone at 1-800-772-1213
- At your local Social Security office
📆 Don’t miss critical deadlines! Check out our Key Medicare Dates and Deadlines resource.
Part A and Medicare Supplement Insurance (Medigap)
Original Medicare (Parts A and B) leaves you responsible for deductibles, coinsurance, and copayments that can add up quickly—especially for extended hospital stays or multiple hospitalizations in a year.
Medicare Supplement insurance (Medigap) helps cover these gaps. All standardized Medigap plans cover:
- The Part A coinsurance for hospital days 61-90 ($434/day in 2026)
- The Part A coinsurance for lifetime reserve days ($868/day in 2026)
- An additional 365 days of hospital coverage after Medicare benefits are exhausted
Most Medigap plans also cover the Part A deductible, meaning you’d pay nothing out-of-pocket for your hospital stays after paying your monthly Medigap premium.
Part A and Medicare Advantage Plans
If you choose a Medicare Advantage Plan (Part C) instead of Original Medicare, you still have Part A coverage—the private insurance company just administers it differently. Medicare Advantage plans:
- Must cover everything Original Medicare covers
- Often have different cost-sharing structures
- May charge copays per day instead of using the Part A deductible
- Have annual out-of-pocket maximums (Original Medicare doesn’t)
🛡️ Deciding between Medicare Advantage and Medicare Supplement? Read our detailed comparison guide.
Common Medicare Part A Questions
Can I delay enrolling in Part A?
If you have premium-free Part A, there’s generally no reason to delay enrollment. You won’t pay a monthly premium, and you’ll have coverage if you need hospitalization. However, if you have a Health Savings Account (HSA) and you’re still working, enrolling in Part A will prevent you from making new HSA contributions.
If you would have to pay a premium for Part A, you can delay enrollment if you have other creditable coverage through current employment.
What happens if I don’t have 40 work credits?
If you don’t have 40 work credits, you may qualify for premium-free Part A based on your spouse’s work history (if married or widowed). Otherwise, you can purchase Part A coverage by paying the monthly premium of $311 or $565 (depending on your work credits), but you must also enroll in Part B.
Does Part A cover emergency room visits?
Emergency room visits are typically covered under Part B, not Part A—unless you’re admitted to the hospital as an inpatient. If you’re treated and released from the emergency room, Part B covers 80% of Medicare-approved costs after your Part B deductible.
What if I need more than 100 days in a skilled nursing facility?
Medicare Part A only covers up to 100 days of skilled nursing care per benefit period. After day 100, you’re responsible for all costs. Many people turn to Medicaid, long-term care insurance, or personal funds to cover extended skilled nursing stays.
Planning for Medicare Part A Costs
Understanding your potential Part A costs helps you budget for healthcare expenses in retirement. Consider these planning strategies:
- Budget for the deductible: Set aside at least $1,736 per year for potential hospital stays
- Consider supplemental coverage: Medigap or Medicare Advantage can protect against high out-of-pocket costs
- Review your coverage annually: Your health needs and finances may change
- Ask about admission status: Ensure you’re admitted as inpatient, not observation, when hospitalized
The Bottom Line on Medicare Part A
Medicare Part A provides essential hospital insurance coverage for most Medicare beneficiaries at no monthly cost. Understanding how Part A works—especially benefit periods, cost-sharing, and coverage requirements—helps you make informed healthcare decisions and avoid unexpected bills.
While Part A covers much of your hospital care, significant out-of-pocket costs remain, particularly for extended hospital stays or multiple hospitalizations. That’s why many Medicare beneficiaries choose to supplement their coverage with either a Medigap policy or a Medicare Advantage plan.
The 2026 cost increases for Part A deductibles and coinsurance make it more important than ever to understand your coverage and consider your supplemental insurance options carefully.
Timothy Gibson is an independent licensed insurance broker with 8 years of experience helping individuals and couples navigate Medicare. He can help you understand Part A coverage, explain your supplemental insurance options, and find the plan that fits your health needs and budget.
No cost. No pressure. Just knowledgeable advice tailored to you.