You’re turning 65. It’s a landmark birthday, the one at which you enter “senior citizenship,” by most conventional standards in the United States.
And it’s the age when you need to make vital decisions about your healthcare, particularly regarding Medicare Part A and Part B and other aspects of your health insurance.
It can be confusing, but it’s important to know how Medicare works, what’s covered and the rules that apply to each part so you can prevent gaps in coverage and avoid penalties for failing to sign up when you should.
“Even when you’re dealing with your commercial insurance coverage, that can be challenging,” says Annmarie Kish, with Cleveland Clinic’s Department of Revenue Cycle Management. “But then this change comes and you’re signing up for Medicare, and it’s truly just confusing.”
Read on to get answers to common questions about Medicare Part A and Part B.
What Does Medicare Part A Cover?
Medicare Part A is the hospital component of original Medicare, covering:
- Inpatient hospital care, including the cost of semi-private rooms, general nursing care, medications and other services and supplies. Note: Part A does not cover outpatient emergency room care or an overnight hospital stay for observation. However, if a physician formally admits you to the hospital as an inpatient, Part A typically covers related outpatient hospital services you receive during the three days before your admission date.
- Skilled nursing facility care, including (but not limited to) the cost of semi-private rooms, skilled nursing services, medications and medical supplies/equipment.
- Hospice care, including end-of-life care services.
- Limited home healthcare, including part-time/intermittent, at-home skilled nursing care deemed medically necessary after an inpatient stay at a hospital or skilled nursing facility.
- Inpatient rehabilitation services, including physical or occupational therapy, speech pathology and other medically necessary care requiring continued medical supervision and coordinated care at an inpatient rehab center or hospital.
- Inpatient mental health services, including diagnosis and treatment for depression, anxiety and other mental health disorders.
Note that Medicare Part A doesn’t cover all expenses related to a hospital admission because physician services are covered under Medicare Part B. “Part A covers all of the hospital-associated costs,” explains Maura Carley, MPH, CIC, a Medicare expert with Healthcare Navigation, LLC, “but it doesn’t cover the physician costs. Those come under Part B.”
How Much Does Medicare Part A Cost?
If you or a spouse worked long enough—at least 10 years (40 quarters)—and paid Medicare payroll taxes during that time, you qualify for premium-free Part A, meaning your monthly Part A premium is $0.
If you or a spouse fails to meet that 40-quarter requirement, you can purchase Part A, but you must enroll during a valid enrollment period and also enroll in or already have Medicare Part B. The monthly Part A premium is $311 for individuals/spouses who worked and paid Medicare taxes for 7½ to less than 10 years (30 to 39 quarters) and $565 for those who worked for fewer than 7½ years. Note: If you’ve retired just shy of the 40-quarter threshold, you might consider returning to work to earn the final quarters you need to qualify for premium-free Part A.
Is Medicare Part A Free?
Not necessarily. Even if you have earned premium-free Part A, you’ll still have out-of-pocket costs. For example, you’ll pay a deductible ($1,736 in 2026) each time you’re admitted to a hospital per benefit period. This period starts the day you’re admitted and ends when you haven’t received inpatient care for 60 consecutive days. Once that benefit period ends, a new one begins.
As an example, if you’re admitted to a hospital for 10 days and readmitted 20 days later, you’ll remain in the same benefit period and pay the deductible only once. However, if your hospital admissions span multiple benefit periods, you’ll pay the deductible for each period, and there’s no limit to the number of benefit periods you can have.
Moreover, if you remain hospitalized for more than 60 consecutive days and after you’ve met your deductible, you’ll have copayments. In 2026, they are $434 per day if your hospital stay is 61 to 90 days and $868 per day for days 91 to 150 as you use lifetime reserve days—additional days Medicare pays for when you’re hospitalized for more than 90 days (you have 60 reserve days you can use during your lifetime). After day 150, you pay all inpatient costs. For stays in skilled nursing facilities, these copayments are $217 per day from days 21 to 100, and you pay all costs from day 101 and afterward. (Note that many people purchase a separate supplemental Medigap plan to cover the cost of these deductibles and copayments.)
“So, you want to know what your premium is, and be sure you know what your out-of-pocket costs will be,” Kish advises.
Who Is Eligible for Medicare Part A?
Eligibility for Medicare Part A and Part B typically starts at age 65, but it can begin earlier for people who have been deemed totally disabled or diagnosed with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease) or end-stage renal disease.
How Do You Enroll in Medicare Part A?
If you receive Social Security or Railroad Retirement Board (RRB) benefits earlier than age 65, you will be automatically enrolled in Medicare Part A and Part B. If you don’t qualify for automatic enrollment, you must actively enroll in Medicare through the Social Security Administration—you must enroll during a valid enrollment period and also enroll in or already have Medicare Part B.
“The only group that’s automatically enrolled in Medicare at 65 are the people who elect to take Social Security or Railroad Retirement Board benefits,” Carley advises. “Although your initial enrollment period is seven months, most people enroll prior to the month of their birthday to have Medicare in place when they’re first eligible.”
When Does Medicare Part A Coverage Start?
If you’re eligible for premium-free Part A, your coverage begins on the month you turn 65; if your birthday is on the first of the month, your coverage begins the month before. If you postpone enrolling in Medicare Part A, your coverage can be made retroactive for up to six months from when you enroll or apply for Social Security or RRB benefits, Carley says.
If you do not qualify for premium-free Part A and you sign up before your 65th birthday, your coverage begins on the month you turn age 65. If you sign up during the month you turn 65 or the subsequent three months, your coverage begins the month after you sign up. For individuals already receiving Social Security or RRB benefits, coverage typically begins the month after they become eligible for Medicare.
What Are the Medicare Part A Enrollment Periods?
You can enroll in Medicare Part A and Part B during three periods:
- The initial enrollment period, which spans seven months—the three months before your 65th birthday, your birth month and the three months after your 65th
- The general enrollment period (Jan. 1 to March 31 of each year) for people who miss their initial enrollment period or their special enrollment period.
- Special enrollment period, most commonly used by people who have active group coverage through an employer of 20 or more employees through their work or a spouse’s work, or by people who lose this coverage. Uncommonly, it applies to individuals with special circumstances, such as those who miss their initial sign-up due to factors like a natural disaster/emergency. These periods vary in duration, depending on the circumstance.
What Happens If You Miss Your Enrollment Window?
Missing these enrollment periods can lead to delays in coverage. For instance, missing the initial enrollment period forces you to wait until the next general enrollment period to sign up. Then, your coverage will begin the month after you enroll.
Missing your enrollment period also can result in significant financial penalties. While there’s no late-enrollment penalty if you qualify for premium-free Part A, if you have to buy Part A and fail to sign up during your initial enrollment period or a special enrollment period, a 10% penalty will be added to your monthly premium for twice the number of years you were eligible but failed to sign up. So, if you were eligible for Part A for three years but failed to enroll, you’ll pay the penalty for six years.
Furthermore, a 10% penalty is added to your monthly premium for each year you were eligible to sign up for Medicare Part B and did not, and this penalty remains for as long as you have Part B coverage. So, if you wait three years to sign up for Part B and do not meet the criteria for a special enrollment period, you’ll pay a 30% late enrollment penalty in addition to the Part B standard premium. However, if you delay signing up for Part B because you continue to receive health insurance from an employer with more than 20 active employees, you won’t face this penalty (read more in the next section).
“Part B enrollment rules are structured to be extremely punitive,” Carley says. “So, you want everybody to be going on Medicare either during an initial enrollment period, which is around their 65th birthday, or a special enrollment period, which is usually triggered by retirement. Then, the only other way to get on Part B is through the general enrollment period. That’s the first quarter of every year, and most people who do that are going to pay a lifetime premium penalty for their Part B.”
What If I Work Past Age 65?
If you (or your spouse) are still working past age 65, you can keep your employer’s health insurance plan and coordinate your Medicare benefits with that coverage, depending on the size of the employer—it must be creditable coverage, meaning that it pays as much or more than Medicare. If your employer has 20 or more active employees, you can delay signing up for Part B without facing a penalty once you retire.
“But if it’s a smaller company, in most states you have to enroll in Part A and B when you turn 65,” Kish advises. “So, it’s a good idea to sign up for Part A, and then, depending on the size of your company and the coverage, you might delay Part B.”
“If you’re with a group that has 20 or more employees, usually you’re being offered coverage that’s heavily subsidized, so you generally don’t want to consider going on Part B because you have to pay a premium for that,” Carley adds. “If you’re one of those people who has group coverage, the real question is should you sign up for Part A? In my opinion, most people should, unless they want to contribute to a health savings account.”
It’s important to note that if your larger employer offers subsidized COBRA insurance upon your retirement, that coverage becomes secondary to Medicare once you become Medicare-eligible. COBRA does not count as creditable employee coverage. As such, be sure to enroll in Medicare Part B during your eight-month special enrollment period once you retire, as failing to do so will result in penalties, Carley notes.
“If you elect COBRA, which you’re often tempted to do if it’s subsidized for a period of time, you’re at much greater risk for missing the deadline of your special enrollment period,” she says. “COBRA is a big issue that we see. So is missing your enrollment window. People don’t realize how punitive the system is.”
Can You Cancel Medicare Part A or Part B?
“Most people would never consider cancelling Medicare Part A or B,” Carley says. However, if you return to the workforce and are offered active group coverage through a large employer, you are able to cancel Part B.
Medicare Part A and Part B: What’s the Difference?
Whereas Medicare Part A (hospital insurance) covers your inpatient care at a hospital or skilled nursing facility, Medicare Part B (medical insurance) covers outpatient care and services from physicians and other healthcare providers, as well as physician services provided while you’re an inpatient. It also covers home healthcare, preventive services (e.g., health screenings, vaccines and annual wellness visits) and the cost of durable medical equipment (e.g., walkers, wheelchairs and hospital beds).
“Most people aren’t planning on hospital admissions, but they are planning on doctor’s visits and wellness checkups,” Kish says. “That’s why you need Part B.”
With Part B, you pay a one-time deductible ($283 in 2026) before coverage begins. From there, Part B usually pays 80% of the cost of approved services, and you’re responsible for the remaining 20% coinsurance payment.
A key difference between Part A and Part B is that while most people qualify for premium-free Part A, Part B recipients pay a monthly premium—$202.90 for most recipients in 2026, with the amount projected to rise to $209.50 in 2027, according to the 2026 Medicare Trustees Report. Based on Medicare’s income-related monthly adjustment amount (IRMAA), if your adjusted gross income exceeds $109,000 in 2026 ($218,000 if you’re married and file a joint tax return), your monthly premium increases to anywhere from $284.10 to $689.90, depending on your income. Most beneficiaries have their Part B premiums automatically deducted from their Social Security.
How Can I Find Assistance?
Understanding the nuances of Medicare enrollment, your coverage and costs can be challenging, but you can find help (see “Medicare Resources”).
“Medicare coverage has gotten better and better,” Carley says. “It’s just gotten more and more complicated.”
If necessary, seek advice from a licensed Medicare broker or consultant, who can guide you in the process and advise you about your options, Kish says: “I would personally recommend that. They know what’s available, what your specific health needs are and what you can afford. Do your research on the broker, and check with your providers and different health systems to see who they recommend, because then you know they’re vetted and there to help you.”
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