Key Takeaways
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Medicare Part A provides important hospital coverage, but it does not cover every cost you might assume it does. Understanding these gaps can help you prepare financially and avoid surprises.
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Knowing what is and isn’t covered under Part A allows you to plan more effectively for your healthcare needs in 2025 and beyond.
What Medicare Part A Actually Covers
Medicare Part A is often referred to as hospital insurance. While that might sound like it covers everything related to a hospital stay, the reality is more complex. Here’s what it generally covers:
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Inpatient hospital care in a Medicare-approved hospital, including a semi-private room, meals, general nursing, and hospital services and supplies.
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Skilled nursing facility (SNF) care after a qualifying hospital stay of at least three days.
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Hospice care for individuals with a terminal illness and a life expectancy of six months or less.
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Home health care, but only in very limited circumstances and only if you meet specific criteria.
While these services are essential, the scope of coverage is limited by duration, conditions, and costs that you are still responsible for.
The Limits of Hospital Coverage
Inpatient Hospital Stays
Even when you’re admitted to a hospital, Medicare Part A doesn’t pay for everything. Here’s what it leaves out:
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Deductibles: In 2025, you pay an inpatient hospital deductible before Part A starts to pay.
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Coinsurance: After 60 days in the hospital, you are responsible for daily coinsurance amounts that increase the longer you stay.
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Private rooms: If you request a private room, Part A will not cover it unless it is medically necessary.
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TVs and phones: These amenities are not covered by Part A unless the hospital includes them at no extra cost.
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Personal items: Items like razors, slippers, or newspapers are considered non-medical and are your responsibility.
Skilled Nursing Facility Care
Skilled nursing facility care is another area where many people misunderstand the limits of Part A. Here’s what you need to know:
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Qualifying stay: You must have been admitted to a hospital as an inpatient for at least three days before Part A will cover SNF care.
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Limited coverage: Part A covers up to 100 days in a SNF per benefit period—but only the first 20 days are fully covered. After that, coinsurance applies.
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Custodial care is not covered: If you need help with daily activities such as bathing or dressing, this is considered custodial care and is not covered by Part A.
Hospice Care
Hospice under Part A is comprehensive but still includes certain exclusions:
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Prescription drugs for symptom control and pain relief are covered, but if you need drugs that are not related to your terminal illness, they may not be included.
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Room and board: If you’re receiving hospice care at home or in a facility that isn’t a Medicare-approved hospice facility, you may need to cover room and board.
Home Health Care
Home health care through Part A is only covered under strict criteria:
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You must be homebound and require intermittent skilled nursing care or therapy.
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You must have a face-to-face meeting with a doctor before receiving home health services.
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Even if these requirements are met, Part A does not cover full-time nursing care, meal delivery, or help with daily tasks like bathing.
What Part A Leaves You to Pay
Medicare Part A comes with several out-of-pocket costs, especially if your stay is extended or you need multiple services in one benefit period.
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Deductible: In 2025, the hospital deductible is $1,676 per benefit period.
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Coinsurance:
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Days 1–60: $0 coinsurance for each benefit period.
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Days 61–90: $419 per day.
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Days 91 and beyond: $838 per each “lifetime reserve day” (up to 60 days over your lifetime).
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After lifetime reserve days are used: all costs are your responsibility.
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Skilled Nursing Facility coinsurance:
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Days 1–20: $0
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Days 21–100: $209.50 per day
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After day 100: all costs fall to you
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These costs add up quickly, especially during lengthy or multiple hospitalizations.
Misunderstood Aspects of Part A
Many Medicare beneficiaries assume that if they go to the hospital or need post-acute care, Medicare will handle everything. That’s not always true.
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Observation status vs. inpatient admission: If you’re under observation in a hospital, even overnight, it may not count toward the three-day inpatient requirement for SNF coverage.
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Outpatient services: Part A only kicks in when you are formally admitted as an inpatient. Otherwise, services might fall under Part B, or worse—not be covered at all if not deemed medically necessary.
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Multiple benefit periods: If you are readmitted to the hospital after 60 days have passed since your last stay, a new benefit period begins. That means a new deductible and possibly new coinsurance responsibilities.
What You Might Need to Consider Separately
Medicare Part A is just one piece of your health coverage. To fill in its many gaps, here are other things to consider:
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Medicare Part B: Covers outpatient care, doctor visits, and preventive services.
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Medicare Part D: Covers prescription drugs.
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Other coverage options: These may help with coinsurance, deductibles, or services Part A does not cover—but you’ll need to explore them separately and understand their own coverage rules.
Planning for Gaps in Coverage
Knowing the limitations of Medicare Part A helps you make more informed choices. Some strategies include:
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Keeping track of hospitalization dates to manage benefit periods.
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Understanding the difference between observation and inpatient status.
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Budgeting for deductibles and coinsurance that could become significant during long stays.
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Exploring additional coverage options if you’re concerned about the costs Part A leaves out.
Final Thoughts on Medicare Part A’s Limits
While Medicare Part A offers essential hospital coverage, it does not pay for everything. Between deductibles, coinsurance, benefit periods, and services it excludes, your out-of-pocket costs could be substantial if you don’t prepare ahead. Understanding what is left out of Part A coverage can help you make more informed healthcare decisions in 2025.
For guidance on how to plan around these gaps, speak with a licensed agent listed on this website. They can help you understand your options and find coverage that works for your needs.
