Key Takeaways

• Medicare Part A covers essential hospital services, but it is not comprehensive; significant out-of-pocket costs can still apply if you stay longer or require non-covered services.

• You must meet specific criteria for Medicare Part A to pay for inpatient hospital care, and it does not cover everything you may assume, such as long-term custodial care.

What Medicare Part A Includes in Hospital Care

Medicare Part A, known as Hospital Insurance, is a foundational component of your Medicare coverage. It typically covers medically necessary inpatient care when you are admitted to a hospital, skilled nursing facility, or hospice.

Here are the major services covered under inpatient hospital care:

• Semi-private room accommodation

• General nursing and hospital services

• Meals and dietary services

• Drugs, supplies, and equipment used during your stay

• Diagnostic and lab tests

• Operating room and recovery services

• Intensive Care Unit (ICU) and Coronary Care Unit (CCU) if required

If your physician certifies that your condition requires inpatient treatment and the hospital formally admits you, Medicare Part A generally covers these services.

Inpatient Hospital Stay Requirements

Medicare doesn’t pay for every hospital visit. To qualify for Part A coverage, you must:

• Be admitted to a hospital as an inpatient (not under observation status)

• Stay in a Medicare-approved hospital

• Require treatment that can only be provided in an inpatient setting

The distinction between being an inpatient and being under observation is critical. Even if you stay overnight in a hospital, if you are classified as under observation, you are considered an outpatient, and Part B—not Part A—applies. This can affect your costs dramatically.

Duration and Coverage Limits

Medicare Part A has specific benefit periods, which begin the day you are admitted and end when you have not received inpatient hospital care or skilled nursing care for 60 consecutive days.

Here is what you are responsible for in 2025:

• Days 1–60: You pay the deductible ($1,676 per benefit period), and Medicare covers the rest.

• Days 61–90: You pay a daily coinsurance of $419.

• Days 91–150: You use your 60 lifetime reserve days and pay $838 per day.

• Beyond 150 days: You are responsible for all costs.

Every time a new benefit period starts, the deductible resets. This can mean multiple deductibles in one year if you are hospitalized again after 60 days of no inpatient care.

Hospital Services Medicare Part A Does Not Cover

While Medicare Part A does provide critical hospital coverage, there are major gaps that often surprise beneficiaries:

• Private duty nursing: Not covered unless medically necessary and ordered by your physician

• TVs, phones, and personal comfort items: These are typically out-of-pocket

• Long-term custodial care: Part A does not cover stays in a nursing home for help with daily living activities if skilled care is not needed

• Care outside of a Medicare-approved hospital: If the facility is not certified by Medicare, you bear the full cost

It is essential to understand that hospital care under Medicare Part A is designed to be short-term and medically necessary. Extended recovery stays and non-medical assistance fall outside its scope.

How Observation Status Creates Hidden Costs

One of the most misunderstood elements of Medicare Part A hospital coverage is the difference between inpatient and observation status.

Hospitals sometimes place patients under “observation” even when they stay overnight. This classification is technically outpatient, which means:

• Part A does not apply

• You may owe more in copayments under Part B

• It will not count toward the 3-day inpatient stay required for skilled nursing facility (SNF) coverage

This nuance becomes financially significant if you later need SNF care. Without a 3-day inpatient hospital stay, Medicare Part A will not cover SNF services.

Transition to Skilled Nursing Facility (SNF) Care

Medicare Part A does cover SNF care, but only under strict conditions:

• You must have had a prior hospital inpatient stay of at least 3 days (not counting the discharge day)

• You must enter the SNF within 30 days of hospital discharge

• A doctor must certify that you need daily skilled nursing or therapy care

Here’s how Medicare covers SNF in 2025:

• Days 1–20: Medicare covers full cost

• Days 21–100: You pay $209.50 per day in coinsurance

• Beyond 100 days: You are responsible for all costs

This coverage is not designed for long-term care. Once your need for skilled services ends or you exhaust your benefit days, Medicare Part A coverage stops.

Hospice Care Coverage Under Part A

If you have a terminal illness with a life expectancy of six months or less, Medicare Part A covers hospice care. You must choose to forgo curative treatment and instead receive palliative services.

Covered hospice services include:

• Pain and symptom management

• Nursing services

• Counseling and social services

• Medical equipment and supplies related to the terminal condition

• Inpatient respite care (up to 5 consecutive days at a time)

Hospice care can be provided at home, in a hospice facility, or in a hospital. Medicare typically covers all hospice costs with very few copayments.

Home Health Care Limitations

Part A may also cover limited home health care services following a hospital or SNF stay if:

• You are homebound

• A doctor certifies the need for skilled care

• Services are medically necessary and part-time or intermittent

Services may include skilled nursing, physical therapy, and speech-language pathology. However, custodial care like bathing or housekeeping is not covered.

If you haven’t had a recent hospital or SNF stay, Part B rather than Part A usually covers these services.

Out-of-Pocket Hospital Costs Add Up

Even though Medicare Part A covers much of your inpatient care, the cost structure can still lead to high out-of-pocket expenses, particularly if:

• You have multiple hospitalizations within a year

• You need a lengthy stay exceeding 60 or 90 days

• You need services not covered by Medicare (like custodial care)

Without supplemental insurance or a Medigap plan, these costs can impact your retirement budget substantially.

You should also be aware that Medicare does not impose an annual out-of-pocket limit on your Part A expenses. This is different from some other types of insurance where your annual spending is capped.

Planning for Gaps in Coverage

Given the limits and exclusions of Medicare Part A, it’s critical to plan ahead. You may want to:

• Consider a Medigap plan to cover Part A coinsurance and deductibles

• Look into Medicare Advantage plans that bundle Part A, Part B, and often Part D

• Save for medical emergencies that might lead to extended hospital stays

Additionally, reviewing your benefits annually during the Medicare Open Enrollment Period (October 15 to December 7) helps ensure your plan continues to meet your needs.

Where to Get Help Understanding Hospital Coverage

If you’re unsure whether your situation meets Medicare’s inpatient care rules, or you need help comparing your cost-sharing options, licensed agents can help. It’s important to have guidance tailored to your health history, financial situation, and long-term goals.

What to Do When Medicare Part A Isn’t Enough

Understanding what Medicare Part A offers—and what it doesn’t—can help you avoid unexpected hospital bills. Hospital coverage under Medicare Part A serves as a vital safety net, but it has time limits, financial caps, and strict definitions of inpatient care. You need to know exactly how your care is classified and what’s excluded so that you can protect your finances and health.

If you want personalized guidance or support with understanding your options, reach out to a licensed agent listed on this website.