Key Takeaways
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Medicare Part A covers hospital stays, skilled nursing care, hospice, and limited home health services, but it does not cover long-term care, most dental services, or routine vision and hearing care.
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While many qualify for premium-free Part A, some must pay a monthly premium based on their work history.
Understanding Medicare Part A: What It Covers and Where It Falls Short
Medicare Part A is a critical part of your healthcare coverage once you become eligible for Medicare. It helps cover many essential medical services, but it doesn’t cover everything. Understanding what’s included—and what’s not—can help you plan ahead for healthcare costs and avoid unexpected surprises.
What Medicare Part A Covers
Medicare Part A primarily provides hospital insurance, meaning it covers inpatient services and certain types of care that require hospitalization or skilled nursing. Here’s what you can expect it to cover:
1. Inpatient Hospital Stays
If you are admitted to a hospital for treatment, Medicare Part A helps cover:
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Semi-private room
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Meals
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General nursing care
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Medications given as part of inpatient treatment
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Other hospital services and supplies
However, you must meet your deductible before Medicare pays its share. For 2025, the inpatient hospital deductible is $1,676 per benefit period. After you’ve met this amount, Part A covers most costs for up to 60 days. Beyond that, you pay daily coinsurance fees.
2. Skilled Nursing Facility (SNF) Care
Medicare Part A covers care in a skilled nursing facility, but only under certain conditions. You must have spent at least three days as an inpatient in a hospital before Medicare will pay for a SNF stay. If you qualify, Medicare covers:
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Semi-private room
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Meals
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Skilled nursing services
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Physical and occupational therapy
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Medications and medical equipment used during the stay
Medicare covers the first 20 days in full, but starting on day 21, you’ll pay a daily coinsurance charge ($209.50 per day in 2025). After 100 days, Medicare stops covering the cost.
3. Hospice Care
If you are terminally ill and choose hospice care, Medicare Part A covers:
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Doctor and nursing services
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Medications for symptom control and pain relief
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Medical equipment and supplies
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Short-term inpatient and respite care
Hospice care is available for as long as your doctor certifies that you need it, with no specific time limit.
4. Limited Home Health Care Services
Medicare Part A covers some home health care services, but only if they are deemed medically necessary. This includes:
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Intermittent skilled nursing care
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Physical, occupational, and speech therapy
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Medical social services
Part A does not cover 24/7 home care, meals, or housekeeping services.
What Medicare Part A Does Not Cover
While Medicare Part A covers many essential services, there are significant gaps in coverage. Some of the biggest exclusions include:
1. Long-Term Care (Custodial Care)
Many people assume Medicare covers nursing home stays indefinitely, but this is not the case. Medicare only covers short-term skilled nursing care after a qualifying hospital stay. If you need long-term care—such as assistance with bathing, dressing, and eating—you will have to pay for it yourself or rely on Medicaid if you qualify.
2. Most Dental, Vision, and Hearing Services
Medicare Part A does not cover:
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Routine dental exams, cleanings, fillings, dentures
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Eye exams for glasses or contacts
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Hearing aids or routine hearing exams
You would need to pay for these services out of pocket or enroll in additional coverage.
3. Prescription Drugs for Outpatient Use
While Part A covers medications administered during hospital stays, it does not cover prescriptions that you take at home. For prescription drug coverage, you need a Medicare Part D plan.
4. Routine Checkups and Preventive Care Beyond Hospitalization
Medicare Part A is designed for inpatient care, so it does not cover routine doctor visits, preventive screenings, or wellness exams. These fall under Medicare Part B.
Why Medicare Part A Is Not Free for Everyone
You might have heard that Medicare Part A is “free.” This is only true for those who have worked and paid Medicare taxes for at least 10 years (40 quarters). If you don’t meet this requirement, you must pay a monthly premium to get Part A coverage.
How Much Does Medicare Part A Cost?
For 2025, the standard monthly premium for those who don’t qualify for premium-free Part A is:
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$518 per month for those with fewer than 30 quarters of Medicare-covered work
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$284 per month for those with 30-39 quarters
This cost is in addition to any Medicare Part B premiums you may have.
How Can You Qualify for Premium-Free Medicare Part A?
You can get Part A at no cost if:
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You (or your spouse) worked and paid Medicare taxes for at least 10 years
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You are receiving or are eligible to receive Social Security or Railroad Retirement Board benefits
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You were a government employee who paid into Medicare
Planning for the Gaps in Medicare Part A
Since Medicare Part A does not cover everything, it’s important to plan ahead for potential out-of-pocket costs. Here are a few steps you can take:
1. Know Your Out-of-Pocket Costs
Even if you qualify for premium-free Part A, you’ll still be responsible for deductibles, coinsurance, and services not covered. Make sure you budget for these expenses.
2. Consider Additional Coverage
Many people choose to enroll in other Medicare coverage to fill in the gaps, such as:
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Medicare Part B: Covers doctor visits, outpatient care, preventive services
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Medicare Part D: Helps with prescription drug costs
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Other forms of coverage: Some may qualify for Medicaid or employer-sponsored plans
3. Look Into Long-Term Care Options
Since Medicare does not cover long-term care, it’s important to explore other ways to pay for future care, such as:
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Long-term care insurance
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Medicaid (if eligible)
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Personal savings or other financial planning
Make the Most of Your Medicare Coverage
Understanding Medicare Part A is key to avoiding unexpected medical expenses and making informed healthcare decisions. Since it only covers hospital-related services, you may need additional coverage to fully protect yourself against high medical costs.
To explore your Medicare options and ensure you’re making the right choice for your health and finances, get in touch with a licensed agent listed on this website. They can provide expert guidance tailored to your needs.
