What Medicare Part A Covers
Part A is hospital insurance. According to Medicare.gov, it covers:
- Inpatient hospital care. Room and board, nursing care, meals, and most treatments during a covered hospital stay.
- Skilled nursing facility (SNF) care. After a qualifying hospital stay of at least 3 days, Part A covers up to 100 days in a skilled nursing facility.
- Hospice care. For people with a terminal illness and a life expectancy of 6 months or less if the illness runs its normal course.
- Some home health care. Part-time skilled nursing care and therapy services ordered by a doctor.
Part A does NOT cover long-term custodial care (help with bathing, dressing, eating). That is a common misunderstanding that catches people off guard financially.
Part A Costs in 2026
Most people pay $0 in monthly premiums for Part A. You qualify for premium-free Part A if you or your spouse worked and paid Medicare payroll taxes for at least 40 quarters (10 years).
If you have 30 to 39 work quarters, the 2026 Part A premium is $311 per month. Fewer than 30 quarters means $565 per month.
The Part A deductible in 2026 is $1,736. This is not an annual deductible. It applies per benefit period. A benefit period starts when you enter a hospital and ends when you have been out of the hospital or SNF for 60 consecutive days. You could pay this deductible more than once in the same year if you have separate hospital stays.
Part A coinsurance for hospital stays in 2026:
| Hospital Stay | What You Pay (2026) |
|---|
| Days 1-60 | $0 (deductible applies at admission) |
| Days 61-90 | $434 per day |
| Days 91+ (lifetime reserve days) | $868 per day |
| Beyond 150 days | 100% of all costs |
For skilled nursing facility care, Part A covers days 1-20 at $0 coinsurance. Days 21-100 cost $217.00 per day in 2026. After day 100, you pay everything.
What Medicare Part B Covers
Part B is medical insurance. It picks up the services that happen outside a hospital stay. According to CMS, covered services include:
- Doctor visits. Appointments with your primary care doctor, specialists, and surgeons.
- Outpatient care. Surgery, observation stays, emergency room visits that do not lead to hospital admission.
- Preventive services. Annual wellness visits, flu and pneumonia shots, cancer screenings, cardiovascular disease screenings, and diabetes monitoring, many at no cost when you see a participating provider.
- Durable medical equipment (DME). Wheelchairs, walkers, CPAP machines, and blood sugar monitors.
- Mental health care. Outpatient mental health services and some partial hospitalization programs.
- Ambulance services. When medically necessary transport to a hospital or SNF is needed.
Part B does NOT cover routine dental, vision, or hearing care. It also does not cover prescription drugs taken at home. That falls under Part D.
Part B Costs in 2026
The standard monthly Part B premium in 2026 is $202.90, up $17.90 from $185.00 in 2025. The annual deductible is $283 in 2026. After you meet the deductible, Part B pays 80% of the Medicare-approved amount for covered services. You pay the remaining 20% with no annual cap, which is why many people add a Medigap (supplemental) policy.
Part B IRMAA surcharges for higher earners (2026):
If your 2024 modified adjusted gross income (MAGI) exceeded certain thresholds, you pay more than the standard premium. CMS sets these IRMAA tiers each year.
| 2024 Individual MAGI | 2024 Joint MAGI | 2026 Monthly Part B Premium |
|---|
| $109,000 or less | $218,000 or less | $202.90 |
| $109,001 - $137,000 | $218,001 - $274,000 | $284.10 |
| $137,001 - $171,000 | $274,001 - $342,000 | $405.80 |
| $171,001 - $205,000 | $342,001 - $410,000 | $527.50 |
| $205,001 - $499,999 | $410,001 - $749,999 | $649.20 |
| $500,000 or more | $750,000 or more | $689.90 |
Medicare Eligibility: Who Qualifies for Part A and Part B
Both Part A and Part B are available to you if you meet any of the following, per Medicare.gov:
- You are 65 or older AND a U.S. citizen or permanent legal resident who has lived in the United States for at least 5 continuous years.
- You are under 65 and have received Social Security or Railroad Retirement disability benefits for at least 24 months.
- You have end-stage renal disease (ESRD) requiring dialysis or a kidney transplant.
- You have amyotrophic lateral sclerosis (ALS). Medicare starts the same month your disability benefits begin, with no 24-month wait.
There is no income limit to qualify for Medicare. This is distinct from Medicaid, which has income thresholds. You can also qualify for Medicare Savings Programs that help pay Part A and Part B costs if your income is low. Use the CoveredUSA screener to check if you qualify for Medicare Savings Programs alongside your Medicare coverage.
How to Enroll in Medicare Part A and Part B
Enrollment windows in 2026
Initial Enrollment Period (IEP): A 7-month window starting 3 months before the month you turn 65, including your birthday month, and ending 3 months after. This is your primary enrollment window. Enrolling in the first 3 months means coverage starts the month you turn 65.
General Enrollment Period (GEP): January 1 through March 31 each year. For people who missed their IEP. Coverage starts July 1.
Special Enrollment Period (SEP): If you are still working at 65 and covered under employer insurance with 20+ employees, you can delay Medicare without penalty. Your SEP runs for 8 months after that employer coverage ends.
Step-by-step enrollment
- Confirm whether you will be automatically enrolled. If you are already collecting Social Security or Railroad Retirement benefits before you turn 65, you are typically enrolled in Part A and Part B automatically. You will receive your Medicare card about 3 months before your 65th birthday.
- If not automatic, apply at SSA.gov. Visit ssa.gov/medicare to apply online. You can also call 1-800-772-1213 or visit your local Social Security office.
- Decide whether to enroll in Part B. If you have qualifying employer coverage, you may choose to delay Part B. Document your decision carefully. If you delay without qualifying coverage, late enrollment penalties apply.
- Gather documents you will need. See the checklist below.
- Choose how to receive your benefits. Original Medicare (Part A + B alone) or through a Medicare Advantage plan (Part C), which bundles both parts with often added benefits. A separate Part D plan covers prescription drugs.
- Consider supplemental coverage. Original Medicare has no out-of-pocket maximum. A Medigap policy fills cost-sharing gaps.
Documents needed for Medicare enrollment
- Social Security card or number
- Birth certificate or other proof of age
- Proof of U.S. citizenship or lawful residency (if applicable)
- W-2 forms or self-employment records (to document work history for Part A premium-free eligibility)
- If delaying Part B: documentation of current employer group health plan coverage
Common reasons Medicare applications get delayed or denied
- Insufficient work history documented (no proof of 40 qualifying quarters)
- Immigration or citizenship status not confirmed
- Residency in the U.S. for fewer than 5 continuous years
- Missing or incomplete documents
- Applying outside of an enrollment window without a qualifying Special Enrollment Period
The Part B Late Enrollment Penalty
This is one of the most financially costly mistakes Medicare-eligible people make. If you do not have qualifying employer coverage and you wait to enroll in Part B after your IEP ends, you pay a 10% premium penalty for each 12-month period you were eligible but did not enroll. That penalty is permanent.
Example: If you delay Part B enrollment by 3 years without qualifying coverage, your 2026 premium of $202.90 increases by 30%, adding about $60.87 per month, every month for the rest of your life.
The penalty does not apply if you had coverage through an employer with 20 or more employees. Medicare.gov's penalty page has the full rules and a penalty estimator.
What Original Medicare Does Not Cover
Original Medicare (Part A plus Part B) has notable gaps. Planning around them matters:
- Prescription drugs taken at home (requires separate Part D coverage)
- Routine dental (cleanings, fillings, dentures)
- Routine vision (eye exams, eyeglasses)
- Routine hearing (exams, hearing aids)
- Long-term custodial care (assisted living, nursing home room and board beyond skilled nursing)
- Care received outside the U.S. in most cases
- No out-of-pocket maximum. Catastrophic hospital costs can be unlimited without supplemental coverage
Many people address these gaps through Medicare Advantage (Part C) plans, Medigap policies, or state-specific programs.
Medicare Savings Programs: Help Paying Part A and Part B Costs
If your income is limited, you may qualify for a Medicare Savings Program (MSP). These are state-administered programs funded jointly by states and Medicaid. They can pay your Part B premium ($202.90/month in 2026), your deductibles, and some or all coinsurance costs.
The four MSP types and their 2026 general income guidelines:
| Program | Who It Helps | What It Pays |
|---|
| Qualified Medicare Beneficiary (QMB) | Income up to 100% FPL | Part A and B premiums, deductibles, coinsurance |
| Specified Low-Income Medicare Beneficiary (SLMB) | Income 100%-120% FPL | Part B premium only |
| Qualifying Individual (QI) | Income 120%-135% FPL | Part B premium only |
| Qualified Disabled and Working Individuals (QDWI) | Income up to 200% FPL; under 65, disabled | Part A premium only |
The 2026 Federal Poverty Level for a single person is $15,960. For a household of two, it is $21,640. MSP income limits are calculated as a percentage of these figures.
Income eligibility by household size for Medicare Savings Programs (QMB, 2026):
| Household Size | 100% FPL (2026), QMB Limit |
|---|
| 1 | $15,960 |
| 2 | $21,640 |
| 3 | $27,320 |
| 4 | $33,000 |
| 5 | $38,680 |
| 6 | $44,360 |
| 7 | $50,040 |
| 8 | $55,720 |
| Each additional | +$5,680 |
Source: aspe.hhs.gov 2026 Poverty Guidelines
Individual states may use slightly higher thresholds. To check your specific state's MSP limits and apply, visit Medicaid.gov or your state Medicaid agency.
Check your eligibility now at CoveredUSA. It takes 2 minutes. The CoveredUSA screener checks Medicare Savings Program eligibility alongside other programs in one quick flow.
How Part A and Part B Work Together
In practice, Part A and Part B complement each other throughout a healthcare episode:
- You arrive at the emergency room (Part B applies while outpatient).
- The doctor admits you to the hospital (Part A takes over for the inpatient stay).
- After your stay, you are transferred to a skilled nursing facility (Part A continues).
- You begin outpatient physical therapy after discharge (Part B resumes).
Both parts have separate deductibles and cost-sharing structures. This is why knowing which part applies to each service matters, and why your Explanation of Benefits can look complicated.
Frequently Asked Questions
What is the main difference between Medicare Part A and Part B?
Part A covers inpatient hospital care, skilled nursing facilities, hospice, and some home health care. Part B covers outpatient services, doctor visits, preventive care, durable medical equipment, and ambulance transport. Together they form Original Medicare. In 2026, most people pay $0 for Part A and $202.90 per month for Part B.
Do I have to enroll in both Part A and Part B at the same time?
No. You can enroll in Part A alone without taking Part B, especially if you are still working and have employer-sponsored coverage. However, if you take Part A, you generally cannot use a Health Savings Account (HSA) anymore. Talk to a licensed Medicare counselor before delaying Part B to avoid penalties later.
What happens if I miss my Medicare Part B enrollment window?
If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you must wait until the General Enrollment Period (January 1 to March 31). Coverage then starts July 1. You will also owe a 10% permanent premium penalty for each full 12-month period you delayed enrollment without qualifying coverage.
Does Medicare Part A or Part B cover prescription drugs?
Neither covers drugs you take at home. Part A covers drugs administered during an inpatient hospital stay. Part B covers some drugs administered in a doctor's office (like chemotherapy or infusions). For outpatient prescription coverage, you need a separate Medicare Part D plan or a Medicare Advantage plan that includes drug coverage.
Can I have Part A and Part B while still working?
Yes. If you are 65 or older and still working, you can have Medicare alongside employer coverage. Which plan pays first (primary vs secondary) depends on how many employees your employer has and other factors. Visit Medicare.gov for the coordination of benefits rules.
What is the Part A deductible per benefit period in 2026?
The Part A inpatient hospital deductible is $1,736 per benefit period in 2026, up from $1,676 in 2025. This is not an annual deductible. If you have two separate hospitalizations in the same calendar year with a 60-day gap between them, you could owe the deductible twice.
How do I know if I qualify for premium-free Part A?
You qualify for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years of work). If you worked 30 to 39 quarters, you pay $311 per month in 2026. Fewer than 30 quarters means $565 per month. Social Security will have your work record on file. You can check at ssa.gov/myaccount.
What does Medicare Part B NOT cover?
Part B does not cover routine dental, routine vision, hearing aids, long-term custodial care, or most prescription drugs taken at home. It also does not cover most care received outside the United States. These gaps are typically addressed through Medicare Advantage plans, Medigap policies, or standalone Part D coverage.
