Medicare Part A Covers Hospital Care—But Watch Out for These Gaps

Key Takeaways

• Medicare Part A covers a wide range of hospital services, but it does not cover everything. You are still responsible for deductibles, coinsurance, and services that fall outside inpatient hospital care.

• Gaps in Part A coverage can result in large out-of-pocket costs, especially for extended hospital stays, skilled nursing facility care, and long-term custodial care. Understanding these gaps helps you make better decisions about supplemental coverage.

What Medicare Part A Actually Covers

When you enroll in Medicare, Part A typically comes first. It’s known as hospital insurance, and in 2025, it remains a core part of your Medicare coverage. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you generally qualify for premium-free Part A.

Part A Covers the Following Services:

• Inpatient hospital care (including semi-private room, meals, nursing care, and medications as part of your treatment)

• Skilled nursing facility care (after a qualifying hospital stay)

• Home health care (if medically necessary and part-time)

• Hospice care (for terminally ill patients)

Each of these benefits comes with specific rules and time limits. Simply having Medicare Part A doesn’t mean all your hospital or related care is fully paid for.

The Costs You’re Still Responsible For

While Part A is described as “premium-free” for most, it does have other costs that catch many people off guard.

Inpatient Hospital Deductible and Coinsurance

• In 2025, the hospital deductible for each benefit period is $1,676.

• For days 1–60 of an inpatient hospital stay, there is no coinsurance after the deductible.

• For days 61–90, you pay $419 per day.

• After day 90, you begin using your lifetime reserve days (you get 60 total), which cost $838 per day.

• Beyond your 60 lifetime reserve days, you pay all costs out-of-pocket.

These amounts reset with each new benefit period, which starts after you’ve been out of the hospital or skilled care for 60 consecutive days.

Skilled Nursing Facility (SNF) Costs

Medicare Part A covers SNF care only after a qualifying 3-day inpatient hospital stay.

• Days 1–20: $0 coinsurance.

• Days 21–100: $209.50 per day.

• After day 100: You pay 100%.

Keep in mind, if you were never admitted as an inpatient (even if you stayed in a hospital bed for days under “observation status”), you won’t qualify for SNF coverage.

Hospice and Home Health Costs

• Hospice care has minimal out-of-pocket costs, like small copays for medications and respite care.

• Home health care is generally fully covered, but only if it’s intermittent and deemed medically necessary. It doesn’t cover 24-hour home care, meals, or personal custodial help.

Gaps You Should Be Aware Of

There’s a common misconception that Medicare covers nearly all healthcare costs in retirement. The truth is, there are significant gaps in Part A alone.

1. Long-Term Care Is Not Covered

Medicare Part A does not pay for custodial or long-term care, even if it’s in a nursing home. If you need help with activities of daily living—like bathing, dressing, or eating—that’s not something Medicare will cover unless it’s part of short-term skilled care.

Most people needing long-term care must pay privately or seek Medicaid after meeting income and asset limits.

2. Hospital Observation Status Doesn’t Count

If you’re kept in a hospital for observation rather than admitted as an inpatient, Medicare Part A won’t kick in. Instead, services fall under Part B, which has different cost-sharing rules and doesn’t qualify you for SNF care.

This technicality can lead to unexpected costs and denied SNF benefits even if you were in the hospital for several days.

3. Out-of-Network and Non-Participating Providers

While most hospital stays are covered under Part A, not every facility accepts Medicare assignment. If you are treated in a hospital or facility that doesn’t participate in Medicare, or uses out-of-network providers, you could face unexpected bills.

Also, certain specialized services during your stay (like private duty nursing or luxury accommodations) may not be covered at all.

4. No Coverage for Personal Comfort Items

Television, phone charges, private rooms (unless medically necessary), and personal convenience items are not covered. These costs can add up quickly, especially during extended hospital stays.

5. Psychiatric Hospital Stays Have a Lifetime Limit

Medicare Part A only covers up to 190 days in a lifetime for inpatient psychiatric care in a freestanding psychiatric hospital. If you need mental health hospitalization beyond that limit, you’ll need alternative coverage or face full costs.

Why Benefit Periods Can Be Financial Traps

A benefit period isn’t tied to the calendar year—it begins the day you’re admitted as an inpatient and ends when you haven’t received any inpatient care for 60 days in a row. This means you can have multiple benefit periods in one year, each with its own deductible.

You could be responsible for more than one $1,676 deductible in the same year if you’re hospitalized more than once with breaks of 60+ days in between. This can lead to much higher costs than expected.

Coverage for Skilled Nursing Care Is Easy to Lose

Many people wrongly assume Medicare will help them if they go to a rehabilitation facility or nursing home after surgery or illness. But if you:

• Were not admitted as an inpatient (only observed)

• Left the hospital before staying 3 full days

• Waited too long to enter the skilled nursing facility after discharge (more than 30 days)

…then your SNF coverage under Part A won’t apply.

Even if you do qualify, after day 20, the daily coinsurance of $209.50 can become burdensome, especially on a fixed income.

The Role of Other Parts of Medicare

Part A only covers inpatient and institutional care. To handle outpatient services, preventive care, durable medical equipment, and more, you need Part B. And to address prescription drugs, you’ll need Part D or equivalent coverage.

Many people consider supplemental policies or other forms of insurance to fill the gaps Part A and B leave behind. These help with costs like deductibles, coinsurance, and services Medicare doesn’t touch—especially for long-term or catastrophic care.

How to Prepare for the Gaps in Part A

Understanding your Part A benefits—and what they exclude—is the first step toward building a more complete healthcare plan in retirement.

Here’s what you can do:

• Track your benefit periods. If you’re hospitalized more than once, understand when a new benefit period begins.

• Confirm your hospital status. Ask if you’re being officially admitted or just under observation.

• Look into additional coverage. Consider policies designed to help with hospital deductibles and extended stays.

• Don’t assume Medicare covers everything. Always ask what is covered—and what’s not—before any major hospital treatment.

• Plan for long-term care. If you expect to need extended assistance later in life, now is the time to explore alternatives beyond Medicare.

Staying Ahead of the Unexpected

Medicare Part A gives you a strong foundation, but that foundation isn’t the whole structure. Without planning for the deductibles, time limits, and outright exclusions, you could be surprised by large bills.

Hospital care is expensive—and while Part A helps tremendously, it’s not a blank check. You’ll want to layer in coverage that aligns with your medical needs, your financial situation, and your long-term plans.

To ensure you’re not caught off guard by these gaps, speak with a licensed agent listed on this website. They can help you understand what your current coverage includes and recommend strategies to strengthen your protection.