What does Part A cover?
- Inpatient hospital care after a doctor formally admits you, including a semi-private room, meals, nursing, and drugs and supplies as part of your inpatient treatment. This includes inpatient care in critical access hospitals, the small rural hospitals that North Carolina has 20 of, and in inpatient rehabilitation facilities.
- Inpatient mental health care in a general or psychiatric hospital. Care in a freestanding psychiatric hospital is limited to 190 days in your lifetime.
- Skilled nursing facility care for a limited time after a qualifying hospital stay, when you need daily skilled nursing or therapy.
- Hospice care if you're terminally ill with a life expectancy of 6 months or less.
- Home health care such as part-time skilled nursing and therapy, if you're homebound and a doctor certifies the need (Part B also covers home health).
Part A doesn't pay for a private room or private-duty nursing unless medically necessary, or for long-term custodial care. Doctors' services during a hospital stay are billed under Part B. More on small mountain and rural hospitals on rural and mountain Medicare in North Carolina.
What does Part A cost in 2026?
| Cost | 2026 amount |
|---|---|
| Premium with 40 or more quarters of Medicare-covered work | None |
| Premium with 30 to 39 quarters | $311 a month |
| Premium with fewer than 30 quarters | $565 a month |
| Hospital deductible, each benefit period | $1,736 |
| Hospital days 1 to 60 | Nothing after the deductible |
| Hospital days 61 to 90 | $434 a day |
| Lifetime reserve days (60 in your lifetime) | $868 a day |
| Skilled nursing days 1 to 20 | Nothing |
| Skilled nursing days 21 to 100 | $217 a day |
CMS sets the 2027 amounts in the fall; as of November 13, 2026 they hadn't been published. See Medicare costs in 2027. A Medigap policy can pay the Part A deductible and coinsurance, and Medicare Advantage plans set their own hospital cost sharing. If your income and savings are limited, NC Medicaid's MQB-Q program (North Carolina's name for QMB) pays the Part A premium for people who owe one, along with Part A and Part B deductibles and coinsurance; see Medicare Savings Programs in North Carolina.
How do benefit periods work?
A benefit period begins the day you're admitted as an inpatient and ends after you've been out of the hospital and any skilled nursing facility for 60 days in a row. If you go back in after that, a new benefit period starts and you owe the deductible again. That means two hospital stays a few months apart can each carry a deductible, while a readmission within 60 days doesn't.
The 3-day rule and observation status
For Part A to cover skilled nursing facility care, you generally need an inpatient hospital stay of at least 3 days in a row, counting the day you're admitted but not the day you're discharged. Time in the emergency room or under observation before you're admitted doesn't count.
If you stay in a North Carolina hospital overnight, ask: "Am I an inpatient or an outpatient?" If you're under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON) explaining your status and what it means for your costs.
Medicare Advantage plans, including the State Health Plan's group Medicare Advantage options, can set their own rules for skilled nursing coverage; check the plan's Evidence of Coverage. Part A stops after 100 skilled nursing days and never pays for long-term custodial care. North Carolina doesn't use an income cap for nursing home Medicaid: your income goes toward the cost of care, and NC Medicaid can pay the rest if you qualify. See NC Medicaid and Medicare.
Appealing a hospital discharge in North Carolina
If you think you're being discharged too soon, you can ask for a fast review by North Carolina's Beneficiary and Family Centered Care Quality Improvement Organization, Acentra Health, at 1-888-317-0751 (TTY 711). Call no later than your planned discharge date. The hospital must give you a notice, An Important Message from Medicare about Your Rights, that explains how. The same organization reviews notices that your skilled nursing, home health or hospice care is ending. More on Medicare appeals in North Carolina.
How do I get Part A?
If you already get Social Security or Railroad Retirement benefits, you're enrolled in Part A automatically at 65. Otherwise, sign up through Social Security online, at 1-800-772-1213 (TTY 1-800-325-0778), or at a Social Security office during your Initial Enrollment Period. If you qualify for Part A with no premium, there's usually no reason to wait, but if you have a health savings account, read working past 65 first: Part A coverage can be backdated up to 6 months when you sign up after 65.
If you must pay a premium for Part A and don't sign up when first eligible, the Part A premium can go up 10% for twice the number of years you could have had it but didn't.
North Carolina public employees and Part A
Unlike states where many teachers and public workers are outside Social Security, North Carolina covers most of its public workforce: in 2023, 92.7% of the state's state and local government employees had Social Security coverage (Congressional Research Service). Those jobs pay the Medicare tax as well, and federal law has required the Medicare tax for nearly all state and local employees hired after March 31, 1986. So most North Carolina teachers, state employees and local government retirees reach the 40 quarters for Part A with no premium. If you're unsure, your Social Security statement at ssa.gov shows your Medicare-taxed earnings.
- State Health Plan retirees: Part A and Part B must both be in effect to enroll in the Plan's group Medicare Advantage Base Plan or Enhanced Plan. If they aren't in effect by the date your retiree coverage starts, you're placed in the 70/30 Plan.
- Still working for the State at 65: the State Health Plan stays primary while you're actively working, and the Plan recommends enrolling in Part A and delaying Part B.
See State Health Plan retirees and Medicare.
Next steps
For questions about your hospital coverage, call 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048). To review how Original Medicare, Medigap and Medicare Advantage handle hospital costs with plans from the companies they work with, you can request a call from a licensed insurance agent. See also Medicare basics, do I have to pay for Part A? and the glossary.
Sources
- Medicare.gov — What Part A covers
- Medicare.gov — Skilled nursing facility care
- Medicare.gov — Hospice care
- Medicare.gov — Inpatient hospital care
- CMS — 2026 Medicare Parts A and B premiums and deductibles
- CMS — Beneficiary notices (MOON and Important Message from Medicare)
- CMS — Beneficiary and Family Centered Care Quality Improvement Organizations
- Acentra Health — BFCC-QIO for North Carolina
- CMS — Hospital General Information (North Carolina critical access hospitals)
- Congressional Research Service — Social Security Coverage of State and Local Government Employees (R46961), Table 1
- Social Security — Mandatory Medicare coverage for state and local government employees
- State Health Plan — Retiring and Medicare presentation, 2026 (Parts A and B requirements)
- NC Medicaid — MA-2252 Non-MAGI income and reserve limits (MQB-Q), effective April 1, 2026 (PDF)
Frequently asked questions
Do I have to pay for Medicare Part A?
Most people don't pay a Part A premium because they or their spouse paid Medicare taxes for at least 40 quarters. With 30 to 39 quarters the premium is $311 a month in 2026, and with fewer than 30 it's $565. Everyone owes the deductible and any coinsurance when they use hospital care.
What is a benefit period?
A benefit period starts the day you're admitted as an inpatient to a hospital or skilled nursing facility and ends when you've gone 60 days in a row without inpatient care. You pay the Part A deductible again in each new benefit period, and there's no limit on how many you can have.
Does Part A cover a nursing home in North Carolina?
Part A covers up to 100 days of skilled nursing facility care per benefit period, but only after a qualifying inpatient hospital stay of at least 3 days and only while you need daily skilled care. It doesn't cover long-term custodial care; in North Carolina that is usually paid privately or by NC Medicaid. Days 21 to 100 cost $217 a day in 2026.
What if the hospital says I'm under observation?
Observation is outpatient care under Part B, even if you stay overnight in a hospital bed, and observation days don't count toward the 3-day stay needed for skilled nursing coverage. If you're under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON). Ask whether you're an inpatient or an outpatient.
How do I appeal if I think I'm being discharged too soon from a North Carolina hospital?
Call North Carolina's Medicare quality improvement organization, Acentra Health, at 1-888-317-0751 (TTY 711) no later than your planned discharge date. The hospital gives you a notice called An Important Message from Medicare that explains the steps. You can generally stay while the review happens without paying for the extra days.
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