What Does Medicare Part a Cover? Budget Seniors, February 26, 2026February 26, 2026 🎯 Key Takeaways: Medicare Part a in 2026 💡 Does Part a pay 100%? No. You face a $1,736 deductible per benefit period before Medicare pays anything for hospital stays, and coinsurance kicks in after day 60. Is Part a free? For roughly 99% of beneficiaries who worked 10+ years paying Medicare taxes, the monthly premium is $0. Everyone else pays up to $565/month. What does Part a cover? Inpatient hospital stays, skilled nursing facility care (after a qualifying 3-day hospital stay), hospice care, and limited home health services. Does Part a cover the emergency room? Only if you’re formally admitted as an inpatient. ER visits alone fall under Part b, not Part a. Does Part a cover surgery? Yes, but only inpatient surgeries where you’re admitted to the hospital. Outpatient surgery is a Part b expense. What about skilled nursing? Part a pays the first 20 days at $0 cost, then $217/day for days 21-100, but only after a qualifying 3-day inpatient stay. How do I know if I’m on Part a or b? Check your red, white, and blue Medicare card. It lists your coverage dates for both Part a and Part b separately. What is 100% covered? Hospice care services carry no deductible, and the first 20 days of skilled nursing have zero copay. Certain preventive services under Part b are also fully covered. State-by-state differences? While Part a benefits are federally standardized, 12 states plus D.C. have eliminated asset limits for Medicare Savings Programs, making it far easier for low-income seniors to get help. The observation status trap? If your hospital puts you under “observation” instead of formally admitting you, Part a won’t cover your stay at all, and you’ll lose eligibility for skilled nursing coverage afterward. 🏥 1. No, Medicare Part a Does Not Pay 100% of Your Hospital Bill — Here’s the Real Breakdown This is the single most dangerous misconception among seniors approaching retirement. One common myth is that Medicare Part a covers all hospital costs without limits. The reality paints a very different picture once you look at the 2026 numbers published by CMS. The Medicare Part a deductible for 2026 is $1,736, an increase of $60 from $1,676 in 2025. That deductible applies per benefit period, not annually. So if you’re admitted, discharged, stay out 60 days, and then get readmitted, you’ll owe another $1,736. Hospital Stay LengthWhat You Pay in 2026What Part a Pays💡 Reality CheckDays 1-60$1,736 deductible (one-time per benefit period)Remaining covered costsYou could owe this amount multiple times per year if you have multiple benefit periods 🏥Days 61-90$434 per day coinsuranceBalance of covered costsA 30-day overstay adds $13,020 to your bill 💸Days 91-150 (lifetime reserve)$868 per dayBalance of covered costsYou only get 60 lifetime reserve days total — use them wisely ⚠️Beyond 150 days100% of all costs$0Medicare stops paying entirely. You need supplemental coverage 🚨 💡 Pro Tip: For skilled nursing facility care, Medicare pays the full cost for the first 20 days. From days 21 through 100, you pay $217 per day if eligibility criteria are met. After day 100 in a skilled nursing facility, you’re responsible for everything. 💳 2. Most Seniors Pay $0 for Part a — But Here’s Who Gets Stuck with a $565 Monthly Bill Here’s the good news first: approximately 99% of Medicare beneficiaries do not have a Part a premium since they have at least 40 quarters of Medicare-covered employment. That’s roughly 10 years of work where Medicare taxes were deducted from your paycheck. But if you or your spouse didn’t hit that 40-quarter threshold, you’ll face one of two premium tiers in 2026: Work History2026 Monthly Premium2025 Premium💡 Who This Affects40+ quarters (10+ years)$0$0The vast majority of seniors ✅30-39 quarters (7.5-10 years)$311/month$285/monthPeople who worked part-time or took extended career breaks 📋Under 30 quarters$565/month$518/monthImmigrants, homemakers, or those who worked primarily in non-covered employment 💰 What most articles don’t tell you: If you don’t qualify for premium-free and delay buying it, you may pay a 10% higher premium for twice the years you waited. So if you delayed enrollment by three years, you’d pay that 10% penalty surcharge for six years. That can add up to thousands of dollars in unnecessary costs. Discover Lifeline Phone Program 📱 🔍 3. How to Know If You’re on Part a, Part b, or Both — It’s Simpler Than You Think Your red, white, and blue Medicare card contains the answer. It clearly lists the effective dates for both Part a (Hospital Insurance) and Part b (Medical Insurance) separately. If you see a date next to “Hospital (Part a),” you’re enrolled. If Part b also shows a date, you have both. Here’s the critical difference between the two: FeaturePart a (Hospital Insurance) 🏥Part b (Medical Insurance) 🩺What it coversInpatient hospital, skilled nursing, hospice, some home healthDoctor visits, outpatient care, preventive services, durable medical equipment2026 premium$0 for most people$202.90/month standard2026 deductible$1,736 per benefit period$283 per yearHow you pay after deductibleCoinsurance kicks in after day 6020% of Medicare-approved amountEnrollmentUsually automatic at 65 if receiving Social SecurityMust actively enroll or face late penalties 💡 Pro Tip: Most people get enrolled in Part a automatically when they turn 65 if they’re already receiving Social Security benefits. Part b requires a conscious enrollment decision and comes with a monthly premium that increases based on income. 🏠 4. What Medicare Part a Actually Covers for Seniors — The Complete Picture Beyond Hospital Stays Part a is far more than just “hospital insurance.” Medicare Part a helps pay for inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also helps cover hospice care and some home health care. Here’s the full scope of coverage, broken down by service type: Inpatient Hospital Care includes a semi-private room, meals, general nursing, drugs administered during your stay, and other hospital services and supplies. This covers medically necessary surgeries, intensive care, and inpatient rehabilitation when you’re formally admitted by a doctor’s order. Skilled Nursing Facility Care covers a semi-private room, meals, skilled nursing and rehabilitative services, and other services and supplies after a qualifying 3-day inpatient hospital stay. Part a covers the first 20 days of SNF care with no copayment. Hospice Care is one of the most generous Part a benefits. Medicare Part a pays the full cost of hospice services, and you only pay a small copayment (up to $5) for each prescription drug and at most 5% of the Medicare-approved amount for any inpatient respite care. Home Health Services include part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social services, and some medical supplies. For home health care under Part a, you pay $0 for covered home health services and 20% of the Medicare-approved amount for durable medical equipment. ServicePart a Covers?Your Cost💡 Critical DetailInpatient hospital stay✅ Yes$1,736 deductible + coinsurance after day 60Must be formally admitted with doctor’s order 📝Inpatient surgery✅ YesCovered under hospital stay costsOutpatient surgery falls under Part b ✂️Skilled nursing facility✅ Yes (days 1-100)$0 for days 1-20, $217/day for days 21-100Requires 3-day qualifying inpatient stay first 🏨Hospice care✅ YesSmall copays for drugs and respite careNo deductible for hospice services 🕊️Home health care✅ Yes (if medically necessary)$0 for services, 20% for equipmentMust be homebound and need skilled care 🏠Inpatient psychiatric care✅ YesSame as hospital stay190-day lifetime limit in freestanding psychiatric hospitals 🧠Long-term custodial care❌ No100% out of pocketPart a only covers skilled care, not assisted living 🚫 🚨 5. The Emergency Room Trap: Part a Only Kicks In If You’re Formally Admitted This is where countless seniors get blindsided by unexpected bills. Part a is sometimes referred to as “hospital insurance.” However, it only covers the costs of an emergency room visit if you’re admitted to the hospital to treat the illness or injury that brought you to the ER. Discover When Can You Sign Up for Medicare?If you visit the emergency room and the doctor treats you and sends you home, or keeps you “under observation,” that entire visit falls under Part b coverage — meaning you’ll pay the Part b deductible ($283 in 2026) plus 20% coinsurance on every service with no cap. The observation status problem is a critical issue that affects seniors nationwide. It is a common misconception that if you stay overnight in the hospital that you are an inpatient. In reality, it is all about your orders. Observation services are hospital outpatient services you get while your doctor decides whether to admit you as an inpatient or discharge you. Your Hospital StatusWhich Part PaysWhat You Owe💡 Impact on Nursing CareFormally admitted as inpatientPart a$1,736 deductible (covers 60 days)Qualifies you for Part a skilled nursing coverage ✅Under “observation” statusPart b20% coinsurance per service — no capDoes not count toward 3-day qualifying stay ❌ER visit, sent homePart b$283 deductible + 20% coinsuranceNo nursing facility eligibility 🚫 💡 Pro Tip: Observation status means you’re an outpatient the whole time, even if you’re in a regular hospital room for days. This distinction matters enormously for your wallet. Always ask your doctor or hospital staff: “Am I admitted as an inpatient or am I under observation?” Get the answer in writing. As of late 2024, you now have appeal rights if the hospital changes your status from inpatient to observation. ✂️ 6. Yes, Part a Covers Surgery — But Only If You Sleep in That Hospital Bed as an Inpatient Medicare Part a covers medically necessary surgical procedures when you’re formally admitted to the hospital. This includes everything from hip replacements and heart bypass surgeries to emergency appendectomies and cancer surgeries requiring inpatient recovery. However, the growing trend in American medicine is toward outpatient surgery, where you go home the same day. Knee arthroscopies, cataract surgeries, many hernia repairs, and even some joint replacements now happen on an outpatient basis. These fall exclusively under Part b, with completely different cost structures. Surgery TypeCovered ByYour 2026 Cost💡 What to KnowInpatient surgery (admitted overnight or longer)Part a$1,736 deductible per benefit periodDoctor’s services during surgery billed separately under Part b 🩺Outpatient/same-day surgeryPart b$283 annual deductible + 20% coinsuranceIncreasingly common — ask your surgeon in advance 🏗️Emergency surgery (admitted after)Part a$1,736 deductibleER visit costs before admission may also be covered under Part a 🚑 💡 Pro Tip: Even during an inpatient surgery covered by Part a, the surgeon’s professional fees are billed separately under Part b. So you’ll owe the Part a deductible for the hospital stay and the Part b coinsurance (20%) for the doctor’s charges. Two different deductibles, two different parts of Medicare, one surgery. 🌍 7. State-by-State: Where You Live Dramatically Affects Your Medicare Part a Costs While Part a benefits themselves are federally standardized (the $1,736 deductible and coinsurance rates are the same in every state), your ability to get help paying those costs varies enormously by state. Medicare Savings Programs (MSPs) are administered at the state level, and some states have far more generous eligibility rules than others. Alabama, Arizona, Connecticut, Delaware, Louisiana, Massachusetts, Mississippi, New Mexico, New York, Oregon, Vermont, and the District of Columbia do not have asset limits for MSPs as of January 2026. This means seniors in those states only need to meet income requirements — they won’t be disqualified for having savings in the bank. Discover Free Grocery Card for SeniorsStates with No Asset Limits for Medicare Savings Programs (2026) 🗺️ StateNo Asset Limit?QMB Income Limit (Individual/Month)💡 AdvantageAlabama✅ No asset test~$1,350Easier qualification for rural seniors 🌾Arizona✅ No asset test~$1,350Benefits desert retirees with modest savings 🌵CaliforniaHas limits, but very high ($130,000 individual)~$1,350Most generous asset limit in the nation 🌴Connecticut✅ No asset testHigher than federal standardOne of the most generous MSP states 🏛️Delaware✅ No asset test~$1,350Small state, big benefit for qualifying seniors 🦀Louisiana✅ No asset test~$1,350Critical for Gulf Coast seniors on fixed incomes 🎷Massachusetts✅ No asset test~$1,350Strong safety net state 📚Mississippi✅ No asset test~$1,350Vital in a state with high senior poverty rates 🌊New Mexico✅ No asset test~$1,350Helps retirees with modest property assets 🏜️New York✅ No asset testQMB expanded to 138% FPLMost expanded MSP eligibility in the nation 🗽Oregon✅ No asset test~$1,350Pacific Northwest seniors benefit 🌲Vermont✅ No asset testQMB expanded to 150% FPLHighest QMB income threshold in the country 🍁Washington, D.C.✅ No asset test~$1,350Federal district matches progressive state standards 🏛️ States with Standard Federal Asset Limits (2026) CategoryIndividualMarried Couple💡 NoteQMB resource limit$9,950$14,910Excludes your home and one vehicle 🏠SLMB resource limit$9,950$14,910Same assets, slightly higher income allowed 📊QI resource limit$9,950$14,910First-come, first-served — apply early each year ⏰ What Each Medicare Savings Program Covers 💰 Program2026 Income Limit (Individual)What It Pays💡 Best ForQMB (Qualified Medicare Beneficiary)~$1,350/month (~100% FPL)Part a & b premiums, deductibles, copays, coinsuranceSeniors with the lowest incomes — most comprehensive help ✅SLMB (Specified Low-Income Beneficiary)~$1,616/month (~120% FPL)Part b premium only ($202.90/month)Those just above QMB limits 📋QI (Qualifying Individual)~$1,816/month (~135% FPL)Part b premium onlyApply early — funding is limited each year ⚠️QDWI (Qualified Disabled Working Individual)~$4,000/month (~200% FPL)Part a premium onlyDisabled workers who returned to employment 🔧 💡 Pro Tip: Starting April 1, 2026, dependent relatives you financially support count toward household size. This raises your income threshold, making qualification easier if you support adult children, grandchildren, or other dependents living with you. This is a brand-new rule change that could help thousands more seniors qualify. 📋 8. Who Is Eligible for Medicare Part a — The Full List Beyond Just “Turning 65” Most people know you become eligible for Medicare at age 65. But the eligibility picture is actually much broader: You qualify for premium-free Part a if you’re 65 or older and you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years). You also qualify if you’re under 65 and have received Social Security Disability Insurance (SSDI) benefits for 24 consecutive months. People diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) may qualify immediately without a waiting period. Eligibility CategoryAge RequirementPremium in 2026💡 Special ConditionsWorked 40+ quarters (or spouse did)65+$0/monthAutomatic enrollment if receiving Social Security ✅Receiving SSDI for 24+ monthsUnder 65$0/monthCoverage begins in month 25 of disability benefits 🩺End-stage renal disease (ESRD)Any age$0/monthCoverage may begin with dialysis or transplant 💊ALS (Lou Gehrig’s disease) diagnosisAny age$0/monthNo 24-month waiting period required 🧠30-39 quarters of work history65+$311/monthReduced premium tier — can buy in voluntarily 📝Under 30 quarters of work history65+$565/monthFull premium — available to lawful permanent residents with 5+ years in the U.S. 🌎 💡 Pro Tip: Immigrants must meet residency rules, typically five years in the U.S. as a lawful permanent resident. Even if you haven’t worked in the United States, you can still purchase Part a coverage — but you’ll pay the full premium, and the late enrollment penalty can make it even more expensive if you don’t sign up when you’re first eligible. 💊 9. What Parts b, c, and d Cover — So You Know Where Part a Ends and the Rest Begins Understanding Part a in isolation is only half the battle. Here’s how each part of Medicare fills in different pieces of the healthcare puzzle: Part b (Medical Insurance) covers doctors’ visits, outpatient procedures, diagnostic tests, ambulance services, mental health care, durable medical equipment like wheelchairs and walkers, and certain preventive services. The standard Part b monthly premium in 2026 is $202.90, with an annual deductible of $283. After the deductible, you typically pay 20% of the Medicare-approved amount. Part c (Medicare Advantage) is offered through private insurance companies and bundles Parts a and b together, often with additional benefits like dental, vision, hearing, and sometimes prescription drug coverage. In 2026, the average monthly Medicare Advantage/Part c premiums will decrease to $14.00, down from $16.40 in 2025. These plans must provide at least the same coverage as Original Medicare but may have different cost-sharing structures and require you to use network providers. Part d (Prescription Drug Coverage) helps cover the cost of prescription medications. The average stand-alone Part d plan total premium is projected to decrease to $34.50 in 2026. The Part d deductible can be no more than $615 per year. A major 2026 benefit: the annual out-of-pocket cap for Part d increases to $2,100, after which you pay $0 for covered drugs for the rest of the year. Medicare PartWhat It Covers2026 Monthly Premium2026 Deductible💡 Key FeaturePart a 🏥Hospital, skilled nursing, hospice, some home health$0 for most$1,736 per benefit periodPremium-free for 99% of beneficiariesPart b 🩺Doctors, outpatient, preventive, equipment$202.90 standard$283 per yearCovers 80% after deductiblePart c 🔄Bundles a + b, often includes d + extras~$14.00 average (plus Part b premium)Varies by planMust cover at least what Original Medicare coversPart d 💊Prescription drugs~$34.50 averageUp to $615/year$2,100 out-of-pocket cap, then $0 for rest of year 🆕 10. The 2026 Changes Nobody’s Talking About: Prior Authorization Comes to Original Medicare This is the under-the-radar development that could impact millions of seniors. In a six-year experiment that began January 1, millions of original Medicare beneficiaries in six states could be required to get advance approval, called prior authorization, before certain medical services, procedures or devices are covered. The states involved in this pilot program include New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. If you live in one of these states, certain medical services under Original Medicare may now require your provider to get approval from Medicare before treatment begins. This is a practice that has long been standard in Medicare Advantage plans but is new to Original Medicare. Additionally, Medicare Part d prescription plan enrollees who qualify will see GLP-1 weight-loss drugs available at $50 a month starting mid-2026, following landmark negotiations with Eli Lilly and Novo Nordisk. And telehealth flexibilities — which allow Americans to access health care while still at home, a crucial benefit for those in rural areas — are also set to end after January 30, 2026. Some extensions may be in the works, but as of now, this is a deadline seniors and caregivers should track closely. 2026 ChangeWho It AffectsImpact💡 Action ItemPrior authorization pilotSeniors in NJ, OH, OK, TX, AZ, WAMay need pre-approval for certain proceduresAsk your doctor if your treatment requires prior authorization ⚠️GLP-1 drug coverage at $50/monthPart d enrollees who qualifyMajor savings on weight-loss and diabetes medicationsCheck with your Part d plan for coverage details starting mid-2026 💊Telehealth flexibility expirationRural and homebound seniorsMay lose access to virtual doctor visitsExplore Medicare Advantage plans that still offer telehealth 📱Part d out-of-pocket cap rises to $2,100All Part d enrolleesSlightly higher ceiling, but still strong protectionAfter $2,100, you pay $0 for covered drugs all year ✅15 more drugs face price negotiationPart d beneficiaries on high-cost drugsExpected savings of billions in coming yearsCheck if your medications are on the negotiation list 📋 ❓ Frequently Asked Questions Does Medicare Part a pay for nursing home care? Part a only covers skilled nursing facility care for up to 100 days after a qualifying 3-day inpatient hospital stay. It does not cover long-term custodial care, assisted living, or nursing home room and board when skilled care isn’t required. This is one of the biggest gaps in Medicare coverage and why many seniors eventually need Medicaid or long-term care insurance. Can I have Part a without Part b? Yes. You can enroll in Part a alone, especially since it’s premium-free for most people. However, if you delay Part b enrollment beyond your initial eligibility period without qualifying coverage elsewhere, you’ll face a 10% premium penalty for each 12-month period you were eligible but didn’t enroll. Does Part a cover ambulance services? Part a covers ambulance transport to the hospital when it’s part of an inpatient admission. If you’re transported by ambulance to the ER but not admitted as an inpatient, ambulance services fall under Part b with a 20% coinsurance after the deductible. What happens if I exhaust my 60 lifetime reserve days? After you’ve used all 60 lifetime reserve days and your benefit period extends past day 90, Medicare Part a stops paying entirely. You’re responsible for 100% of hospital costs. This is why supplemental insurance (Medigap) is so important for seniors who may face extended hospitalizations. Does Part a cover blood transfusions? Part a covers blood during an inpatient stay, but you may have to pay for the first 3 pints of blood per calendar year unless the blood is donated or replaced by a blood bank. After those first 3 pints, Part a covers additional blood at no charge. Can I use my Part a coverage in any hospital? Part a covers you at any hospital that accepts Medicare, which includes the vast majority of hospitals in the United States. Under Original Medicare, you don’t need referrals and you can see any Medicare-accepting provider nationwide. If you have a Medicare Advantage plan, you may be restricted to a network. Data sources: Centers for Medicare & Medicaid Services (CMS) 2026 premiums and deductibles fact sheet published November 14, 2025; Federal Register CY 2026 inpatient hospital deductible notice; Medicare.gov publications; National Council on Aging (NCOA); Center for Medicare Advocacy; KFF Medicaid analysis; AARP 2026 Medicare changes report; Medicare Interactive state-by-state MSP data. All figures reflect calendar year 2026 rates effective January 1, 2026. Recommended Reads What Does Medicare Part B Cover? 20 Full-Care Senior Living Near Me In-Home Senior Care Near Me 20 Best Senior Assisted Living Facilities Near Me Blog