Key Takeaways
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Medicare Part A covers inpatient hospital care, but it doesn’t pay for everything—you may still face substantial out-of-pocket costs.
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Understanding the specific limits and timelines of Part A coverage can help you avoid unexpected expenses during hospital stays.
What Medicare Part A Covers—And Where It Stops
Medicare Part A is designed to cover inpatient hospital care, but it has clear boundaries. You might assume that once you’re admitted to a hospital, Medicare will handle the rest. That assumption can be costly.
Covered Services Under Part A
Part A typically includes:
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Semi-private hospital room
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Meals during your stay
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Nursing services
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Inpatient medications and supplies
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Intensive and coronary care
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Post-hospital skilled nursing care (under strict conditions)
However, there are several hospital-related costs that Part A does not cover, including:
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Private-duty nursing
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A private room (unless medically necessary)
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Personal care items (like razors, socks, or toothpaste)
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Television or phone in your room (if charged separately)
Understanding the Part A Benefit Period
Medicare Part A coverage is based on what it calls a benefit period, not a calendar year. This detail matters more than you might think.
A benefit period starts the day you are admitted to a hospital or skilled nursing facility as an inpatient and ends when you haven’t received inpatient care for 60 consecutive days.
This structure means you could be responsible for multiple deductibles in one year if you have multiple benefit periods. The 2025 inpatient hospital deductible is $1,676 per benefit period.
Hospital Stays: How the Costs Add Up
While Part A does pay for most of your inpatient care, the cost-sharing adds up depending on how long you stay.
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Days 1–60: You pay nothing after the deductible.
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Days 61–90: You pay a daily coinsurance of $419 per day.
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Days 91–150: You pay $838 per day using your 60 lifetime reserve days.
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After 150 days: You are responsible for all costs.
This sliding scale of cost-sharing can result in significant expenses, especially if your hospital stay is lengthy or you use up your lifetime reserve days.
Skilled Nursing Facility Coverage Is Not Unlimited
Many people believe that Medicare will pay for all skilled nursing care following a hospital stay. But in reality, the coverage comes with strict conditions and a time limit.
To qualify, you must:
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Have a prior inpatient hospital stay of at least 3 days (not counting the day of discharge)
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Enter a Medicare-approved skilled nursing facility within 30 days of hospital discharge
If these conditions are met, Part A may cover:
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Days 1–20: Full coverage (you pay nothing)
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Days 21–100: You pay $209.50 per day
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After Day 100: You pay all costs
Note that if you are receiving custodial care only (help with daily activities like bathing or dressing), that is not covered under Part A.
What About Observation Status?
Another pitfall that surprises many beneficiaries is the distinction between inpatient and outpatient (observation) status.
Even if you stay overnight in a hospital, you may be classified as being under observation—which falls under Medicare Part B, not Part A.
Why does this matter?
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Observation status does not count toward the 3-day inpatient requirement for skilled nursing facility care.
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It can lead to higher out-of-pocket costs for hospital services, as Part B has its own deductible and copayments.
Always ask if you’re considered an inpatient or outpatient if you’re admitted to the hospital.
Home Health Care and Hospice: Limited Under Part A
Medicare Part A does offer some home health and hospice benefits, but again, these are conditional.
Home Health Care
You may be eligible for limited home health services under Part A if:
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You’re homebound
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Your doctor certifies that you need intermittent skilled nursing care, physical therapy, or speech-language therapy
Part A does not cover full-time home care, meal delivery, or 24-hour care at home.
Hospice Care
Part A covers hospice if:
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Your doctor certifies that you have a terminal illness with a life expectancy of six months or less
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You choose to receive palliative care instead of curative treatment
Even under hospice care, you may still be responsible for small copayments for medications and respite care.
No Coverage for Long-Term Custodial Care
One of the biggest misconceptions about Medicare is the belief that it covers long-term care. It doesn’t.
Part A only covers short-term stays in skilled nursing facilities under specific conditions. If you need ongoing custodial care—such as help with bathing, dressing, or eating—you’ll need to pay for that out of pocket or through other insurance options.
Long-term care insurance or Medicaid (if you qualify) are often necessary to handle extended nursing home stays.
Hospital Readmissions and Repeat Costs
Because Medicare uses a benefit period model, each new inpatient admission that occurs 60 days after the last one can start a new benefit period—and a new deductible.
This means:
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If you’re hospitalized in January, discharged in February, and readmitted in April, you could face two deductibles in one year.
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These repeat costs can add up, especially for people with chronic conditions or recurring hospitalizations.
Supplemental Coverage Can Help Fill the Gaps
While you can’t change what Part A does or doesn’t cover, you can take steps to reduce your exposure to big bills.
Supplemental insurance, such as a Medicare Supplement (Medigap) plan, may help cover some of the deductibles, coinsurance, and copayments that Medicare Part A leaves behind.
Medigap plans are only available if you have Original Medicare (not a Medicare Advantage plan), and your eligibility and costs may vary.
Also, coordinating Part A with other benefits—like Medicaid, union or employer retiree plans—can offer more complete protection.
Timeframes Matter When You Plan for Costs
Understanding timelines is crucial in managing your Medicare expenses.
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Each benefit period resets after 60 days without inpatient care.
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You only have 60 lifetime reserve days across your entire life.
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Skilled nursing facility coverage is capped at 100 days per benefit period.
When you know these limits, you can plan ahead to avoid overlaps or gaps in coverage.
Hospital Coverage Isn’t a Safety Net Without Holes
Medicare Part A plays a vital role in protecting your health and finances during hospital stays. But it’s not a catch-all solution.
You’re still responsible for deductibles, coinsurance, and services it doesn’t cover at all. More importantly, the structure of benefit periods, inpatient classifications, and coverage timelines can complicate your actual costs.
If you want a clearer understanding of what your coverage options are—or how to protect yourself from large hospital bills—get in touch with a licensed insurance agent listed on this website.
