Key Takeaways

• Medicare Part A places time limits and cost burdens on hospital stays that can result in substantial out-of-pocket costs once you pass 60 days of inpatient care.

• Relying on Part A alone leaves you exposed to gaps in coverage, especially if you experience complications, require post-acute care, or face multiple hospitalizations.

Medicare Part A: What It Covers—And What It Doesn’t

Medicare Part A, also known as hospital insurance, is the foundation of your Medicare coverage. It helps pay for:

• Inpatient hospital stays

• Skilled nursing facility (SNF) care (under specific conditions)

• Hospice care

• Some home health care services

At first glance, the coverage seems broad, and for many people, it feels like a safety net. However, that net has wide holes—especially when your hospital stay exceeds certain day limits or when you need follow-up care.

The 60-Day Window: Where Coverage Begins to Shrink

When you are admitted to the hospital, Medicare Part A begins covering your costs with the assumption that your stay will be short. Here’s how coverage works within a benefit period in 2025:

• Days 1–60: You pay the Part A deductible, which is $1,676 in 2025. After that, Medicare pays for your hospital costs in full for those 60 days.

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

• Days 91–150: You enter your 60 lifetime reserve days—non-renewable days available only once. You pay $838 per day.

• Beyond Day 150: Medicare pays nothing. You are responsible for the full cost of your hospital stay.

As you can see, the deeper you go into a hospital stay, the more financial responsibility shifts to you. And if you already used some or all of your lifetime reserve days in a previous benefit period, they won’t be available to you again.

What Counts as a Benefit Period?

Understanding a benefit period is crucial. A benefit period begins the day you are admitted as an inpatient and ends after you have been out of the hospital or a skilled nursing facility for 60 consecutive days. If you are readmitted after those 60 days, a new benefit period starts—and so does a new deductible.

This means you could face multiple Part A deductibles in a single year if you’re hospitalized more than once, with each hospital stay triggering its own benefit period.

Skilled Nursing Facilities: Limited by Time and Criteria

Many assume that Part A will continue helping with their care once they move to a skilled nursing facility after a hospital stay. That’s only partially true—and only if all conditions are met:

• You must have a qualifying inpatient hospital stay of at least three consecutive days.

• Admission to the SNF must occur within 30 days of the hospital discharge.

• Your care must be medically necessary and provided on a daily basis by skilled professionals.

If these conditions are met, Medicare Part A pays:

• Days 1–20: Full cost covered

• Days 21–100: You pay a coinsurance of $209.50 per day in 2025

• Beyond Day 100: You pay the full cost

Again, this is per benefit period. If you don’t meet the criteria, or if your care extends beyond 100 days, you will face the full cost on your own.

No Coverage for Long-Term Custodial Care

Medicare Part A is not long-term care insurance. If you require help with activities of daily living (such as bathing, eating, or dressing) but do not need skilled nursing care, Part A won’t cover it.

This is where many retirees and their families are caught off guard. Whether care is provided at home, in an assisted living facility, or in a nursing home, you are typically responsible for 100% of the cost unless you have additional insurance.

Readmissions and Chronic Conditions

If you have a chronic illness that leads to frequent hospitalizations, you could face multiple benefit periods within a year. That means:

• Paying the $1,676 deductible multiple times

• Facing coinsurance charges for extended stays

• Depleting your lifetime reserve days quickly

Part A is designed for short-term, acute hospitalizations—not for chronic conditions that require ongoing hospital care or frequent readmissions.

What About Observation Status?

It’s important to know that not all hospital stays are billed as inpatient stays. If you are under “observation status,” Medicare Part A does not apply—Part B does. This classification affects both hospital coverage and whether you qualify for SNF care afterward.

Even if you spend three nights in the hospital, you may be denied coverage for skilled nursing care if those days were considered outpatient observation. This is a costly and often confusing loophole.

Why Additional Coverage Matters

Given these limits, relying solely on Medicare Part A exposes you to:

• High out-of-pocket costs after Day 60 in the hospital

• Repeated deductibles for each benefit period

• No coverage beyond 100 days in a skilled nursing facility

• No coverage for long-term or custodial care

Additional coverage, such as a Medicare Supplement (Medigap) policy or a health plan that includes broader hospital coverage, can help pay for the gaps left by Part A. These options typically cover coinsurance, deductibles, and additional days in the hospital—but each comes with eligibility requirements and costs.

Planning for the Unknown

You can’t always predict how long you’ll be in the hospital or whether your condition will worsen. That’s why relying on the base level of Medicare Part A alone puts your financial and health security at risk.

Consider scenarios that aren’t as rare as they seem:

• A fall leads to surgery and an extended rehabilitation stay

• An infection results in multiple hospital readmissions

• A chronic illness requires repeated hospitalizations

Without additional protection, your care could quickly become unaffordable, just when you need it most.

How Medicare Part A Compares to Other Parts

While Part A covers inpatient hospital costs, Part B covers doctor visits, tests, and outpatient procedures. But neither Part A nor Part B covers everything.

• Part B has a monthly premium ($185 in 2025), a deductible ($257), and 20% coinsurance for most services

• Part D covers prescription drugs, with a $2,000 annual out-of-pocket cap in 2025

• Supplemental coverage is necessary if you want help covering what Parts A and B don’t

Coordinating these parts strategically can reduce your exposure to high costs.

Preventive Steps You Can Take Now

• Review your current Medicare coverage and understand the benefit period rules

• Plan for long-term care needs, especially if you have a chronic health condition

• Talk to a licensed agent listed on this website to explore additional coverage options

• Understand the cost-sharing limits for SNF and hospital stays

• Avoid assumptions about what is covered—read your plan details carefully

A Hospital Stay Can Trigger More Than a Health Crisis

Medicare Part A plays a critical role in your health coverage, but it is not a complete solution. If you experience a long hospital stay, require skilled care afterward, or face frequent admissions, the financial burden can escalate quickly.

To protect your finances and ensure continuity of care, speak with a licensed agent listed on this website. They can help you understand what’s missing from your current coverage and guide you toward solutions tailored to your health needs and budget.