Medicare Part A is the hospital coverage portion of Medicare. For many people who worked and paid Medicare taxes, Medicare Part A is free of charge starting when a person turns age 65.

This article will describe Medicare Part A, especially any coverage changes you or a loved one should know about in 2020.

The government designed Medicare to serve as an “a la carte” menu of options for healthcare. Medicare Part A is the first part of these options (there are also parts B, C, and D). Services covered under Medicare Part A include:

  • home health care
  • hospice care
  • inpatient care in the hospital
  • inpatient care while in a skilled nursing facility
  • skilled nursing facility care

As you can imagine, there are specific rules about services and supplies Medicare covers as well as for how long they will cover them. Medicare coverage may also vary by state and local coverage area.

From year to year, there may be slight variations in coverage and costs for Medicare Part A. For 2020, the main changes to Medicare Part A are related to those in costs, including for the deductible and coinsurance.


Medicare has other parts or options that may cover some of the costs of a hospital stay. Other Medicare options include:

  • Part B: Generally, Medicare Part B does not cover cost for inpatient care, but it may cover services that eventually lead to inpatient care. Part B may cover seeing your doctor, the use of medical equipment, emergency room care, screening tests, and other services that occur as an outpatient.
  • Part C (Medicare Advantage): These are insurance plans sold by private insurance companies. You can shop for these plans at Medicare Advantage plans usually include services of parts A and B. They may also cover prescription drugs, dental, or vision.
  • Part D: This is Medicare’s prescription drug coverage. Part D plans are sold by private insurance companies. There are several Medicare Part D plan types, you buy them from a private company, and there are premiums and other costs.
  • Medicare Supplement (Medigap): These plans help you pay for out-of-pocket healthcare costs and fees that traditional Medicare does not pay such as, copays, coinsurance, and deductibles. Medigap plans are sold by private insurance companies and can help cover costs that Medicare Part A does not.

For the most part, you must be age 65 to enroll in Medicare. To receive Medicare Part A free of charge, you must meet the following criteria:

  • have worked and paid Medicare taxes at least 40 quarters or roughly 10 years (if your spouse worked, but you did not, you can still qualify)
  • receive (or are eligible for) Social Security or Railroad Retirement Board benefits
  • you or your spouse are or were Medicare-covered government employees

If you or a spouse did not work for at least 40 quarters, you can still qualify for Medicare Part A at age 65. The cost of your premium changes based on how long you worked.

Automatic enrollment

The federal government automatically enrolls some people in Medicare Part A. You’re automatically enrolled in Part A if you meet the following criteria:

  • You are already receiving benefits from the Social Security or Railroad Retirement Board.
  • If you have amyotrophic lateral sclerosis (ALS), you will automatically get Part A the month your Social Security disability benefits start.
  • You are younger than age 65 and have a disability from which you receive Social Security benefits.

If you none of these sound like you, then you will need to apply for Medicare Part A.

For the most part, signing up for Medicare Part A depends upon when you turn age 65. You have a 7-month time period during which you can enroll. You can enroll as early as 3 months before your birth month, during your birth month, and up to 3 months after your 65 birthday.

If you don’t enroll during this time period, you could face financial penalties that result in you having to pay more for your healthcare coverage. This also delays how fast your Medicare benefits begin. You can sign up for Medicare Part A (and Part B) during the general enrollment period from January 1 to March 31, but may face penalty fees.

Medicare is a billion-dollar plan. In 2016, Medicare spent $678.7 billion covering an estimated 56.8 million Americans.

The monthly premium costs for Medicare Part A depend upon how long you or your spouse worked.

Medicare Part A Premiums

Time workedPart A monthly premium
40+ quartersfree
30-39 quarters$252
<30 quarters$458

Other people may also qualify for Medicare Part A based on their health, such as if they are disabled, have amyotrophic lateral sclerosis (ALS), or have end stage renal disease (ESRD).

Of course, a free premium doesn’t mean that you won’t pay at all if you find you need hospital care. There are other costs involved with Medicare Part A, several of which have increased for 2020. Many of them revolve around a benefit period, which starts the day you go to a hospital or skilled nursing facility and ends when you haven’t received hospital or skilled care for 60 consecutive days.

Other costs for Medicare Part A

deductible per period$1,408
hospital daily coinsurance fee days 1-60$0
hospital daily coinsurance fee days 61-90$352
hospital daily coinsurance fee days 91+ (reserve days)*$704

*After 90 days of inpatient hospital care, you enter what Medicare calls “lifetime reserve days.” Medicare covers 60 lifetime reserve days total over your lifetime. After a person meets their lifetime reserve days, they are expected to pay all costs.

Costs for skilled nursing care

The costs are also different if you are getting care at a skilled nursing facility. As a general rule, these are the costs:

Days in skilled nursingCost
days 020$0
days 21-100$176 per day
days 100+you are responsible for all costs.

Some people choose to purchase a Medicare supplement policy (also called Medigap) to try and cut back on out-of-pocket costs associated with Medicare Part A and other medical costs. While you may have to spend more on the front end on a Medigap policy, these policies can help to make expenses more predictable because you have less out-of-pocket costs.

enrolling in medicare part a

The Social Security Administration is the body responsible for enrolling people in Medicare. If you’re already receiving Social Security benefits, the service will send you a package in the mail with your Medicare card and an explanation of benefits. The same is true if you get Railroad Retirement benefits.

If you aren’t automatically enrolled, you can sign up for Medicare one of three ways:

  • calling the Social Security Administration at 1-800-772-1213
  • signing up in-person at your Social Security office
  • going online to

If you require hospitalization or skilled nursing care, Medicare Part A can vastly offset your costs. For most people, it is the benefit of having paid Medicare taxes while working.

While the Social Security Administration automatically enrolls many beneficiaries in Medicare parts A and B, not all people are automatically enrolled. There are several ways to accomplish this if you or a loved one is approaching age 65 when your open enrollment period occurs.