Key Takeaways:

1. Medicare Part A covers hospital care, skilled nursing facilities, hospice, and limited home health services, but it has specific limitations and costs to consider.

2. Understanding what Medicare Part A doesn’t cover can save you from unexpected medical expenses and help you plan for supplemental options.

Understanding Medicare Part A: The Foundation of Your Health Coverage

Medicare Part A is often referred to as hospital insurance. It provides essential coverage for inpatient hospital stays, skilled nursing care, hospice care, and some home health services. However, it’s crucial to note that Part A doesn’t cover everything, and knowing these gaps can make a significant difference in managing your healthcare needs.

Let’s break down what’s included, what’s excluded, and how you can prepare for additional costs.

What Does Medicare Part A Cover?

Inpatient Hospital Care

When you’re admitted to a hospital, Medicare Part A steps in to cover the following:

• Semi-private rooms

• Meals

• General nursing care

• Medications administered during your stay

• Necessary tests and treatments

Duration of Coverage: Part A fully covers hospital stays for up to 60 days after you meet the deductible. Beyond 60 days, daily coinsurance applies, and coverage becomes more limited after 90 days.

Skilled Nursing Facility (SNF) Care

Part A also provides coverage for skilled nursing care following a hospital stay of at least three consecutive days. This includes:

• Physical and occupational therapy

• Medications

• Certain medical supplies and equipment

Duration of Coverage: Medicare covers the first 20 days in full, but from days 21-100, you’ll pay daily coinsurance. After 100 days, you’re responsible for all costs.

Hospice Care

If you have a terminal illness and your doctor certifies that you have six months or less to live, Medicare Part A covers hospice care. Services include:

• Pain management and symptom relief

• Medical, nursing, and social services

• Grief counseling for your family

Key Point: Hospice care focuses on comfort rather than curative treatment, so coverage excludes any treatments aimed at curing your illness.

Limited Home Health Services

Medicare Part A may also cover limited home health care services if your doctor deems them medically necessary. This can include:

• Part-time skilled nursing care

• Physical, occupational, or speech therapy

• Medical social services

Eligibility: You must be homebound and under a doctor’s care to qualify.

What Medicare Part A Does Not Cover

While Part A offers substantial coverage, it’s equally important to understand its limitations. Here’s what isn’t covered:

Long-Term Care (Custodial Care)

Medicare Part A does not cover non-medical custodial care in nursing homes or at home. This includes assistance with daily activities like bathing, dressing, and eating.

Private Rooms and Personal Comfort Items

If you’d like a private room or amenities such as a television or phone during your hospital stay, these are out-of-pocket expenses unless medically necessary.

Overseas Medical Care

Medicare Part A generally doesn’t cover medical care received outside the United States. There are rare exceptions, but travel-related emergencies are usually excluded.

Prescription Medications

Medications you take at home are not covered by Part A. You’ll need a separate plan for outpatient prescription drug coverage.

Routine Dental, Vision, and Hearing Services

Basic dental checkups, eyeglasses, and hearing aids are not included under Medicare Part A.

Costs to Watch Out For

Deductibles and Coinsurance

Even with Medicare Part A, you’ll face out-of-pocket costs:

• Hospital Deductible: You’ll pay a deductible for each benefit period. In 2025, this deductible is $1,676.

• Coinsurance for Extended Stays: After 60 days in the hospital, daily coinsurance applies, and after 90 days, lifetime reserve days come into play with higher costs.

Skilled Nursing Facility Costs

While the first 20 days of SNF care are covered in full, you’ll pay daily coinsurance from days 21 to 100. After that, you’re responsible for all costs, which can add up quickly.

Hospice Care Costs

Though most hospice services are covered, you may still pay small copayments for medications and a percentage of the cost for respite care.

Navigating Coverage Gaps

Understanding where Medicare Part A falls short can help you plan better. Here are some steps to consider:

Evaluate Supplemental Insurance

Medigap plans can help cover out-of-pocket costs like deductibles and coinsurance. For example, if you anticipate extended hospital stays or require skilled nursing care, a supplemental plan can provide peace of mind.

Consider Medicare Part B and Part D

While Part A covers inpatient care, Medicare Part B handles outpatient services like doctor visits and preventive care. Part D adds prescription drug coverage, addressing a significant gap in Part A benefits.

Plan for Long-Term Care

Long-term care insurance can fill the gap for custodial care, which Medicare Part A doesn’t cover. Alternatively, explore Medicaid if you meet the income and asset requirements.

Be Prepared for International Travel

If you frequently travel abroad, look into travel insurance or a Medicare Advantage plan with worldwide emergency coverage options.

Tips to Make the Most of Medicare Part A

1. Understand Benefit Periods: A benefit period begins the day you’re admitted as an inpatient and ends when you’ve been out of the hospital or SNF for 60 consecutive days. Knowing this can help you avoid multiple deductibles in a single year.

2. Stay Within Medicare’s Network: Use Medicare-approved facilities and providers to ensure coverage and minimize costs.

3. Keep Documentation Handy: Always have your Medicare card and relevant medical records available for smooth admission and billing processes.

4. Ask Questions: Don’t hesitate to ask your provider whether specific services are covered under Part A.

Common Misconceptions About Medicare Part A

Misconception 1: Medicare Part A Is Free

While many people don’t pay a monthly premium if they’ve worked and paid Medicare taxes for at least 10 years, others may pay up to $518 per month in 2025.

Misconception 2: Medicare Covers All Healthcare Costs

Part A covers significant inpatient care but leaves gaps for routine services and long-term care. Understanding these gaps is critical.

Misconception 3: You’re Automatically Enrolled

Automatic enrollment only applies if you’re already receiving Social Security benefits. Otherwise, you must sign up during your Initial Enrollment Period (IEP).

Why Understanding Medicare Part A Matters

Making sense of Medicare Part A’s coverage and limitations can save you from unexpected expenses. Whether you’re planning for an upcoming hospital stay, evaluating long-term care options, or traveling abroad, being informed is the key to managing your healthcare effectively.

By taking proactive steps—like supplementing Part A with other plans, planning for out-of-pocket costs, and understanding benefit periods—you can make the most of your Medicare coverage while avoiding unnecessary financial stress.

Prepare Yourself for the Gaps in Medicare Part A

Knowing what Medicare Part A does and doesn’t cover empowers you to make informed decisions about your healthcare. Take time to review your coverage, evaluate supplemental options, and plan for future medical needs.