Key Takeaways

• Medicare Part A helps cover major inpatient services, but it doesn’t pay for everything—not even all hospital costs.

• Understanding what isn’t covered under Part A is critical for planning ahead and avoiding unexpected medical bills.

What Medicare Part A Does Cover

Medicare Part A, often referred to as hospital insurance, plays a central role in your Medicare coverage. It primarily helps with the costs associated with:

• Inpatient hospital stays

• Skilled nursing facility care (short-term and under specific conditions)

• Hospice care

• Some home health care

These benefits are invaluable, but only if you meet specific criteria. For instance, inpatient care is only covered if you are officially admitted to a hospital as an inpatient for at least two consecutive midnights. Outpatient services, even those received in a hospital, are not covered under Part A.

Costs You Can Expect Under Part A in 2025

Even though many people qualify for premium-free Part A, there are other costs you must pay:

• Inpatient hospital deductible: $1,676 per benefit period.

• Coinsurance for hospital stays:

  • Days 1–60: $0 (after deductible)

  • Days 61–90: $419 per day

  • Days 91 and beyond: $838 per day (using lifetime reserve days)

• Skilled nursing facility coinsurance:

  • Days 1–20: $0

  • Days 21–100: $209.50 per day

If you exhaust your lifetime reserve days or exceed 100 days in a skilled nursing facility, you are responsible for 100% of the cost.

What Medicare Part A Does Not Cover

While it provides a strong foundation for hospital-related costs, Medicare Part A has important exclusions. Here are major services that fall outside its scope:

1. Long-Term Custodial Care

Medicare Part A does not pay for long-term care, often referred to as custodial care. This includes help with daily activities like bathing, dressing, or eating when it’s the only type of care you need. This type of support, often provided in nursing homes or through in-home aides, is not considered skilled medical care.

2. Outpatient Services

Part A does not cover outpatient hospital services, physician visits, or preventive screenings. These are instead handled by Medicare Part B. If you receive outpatient surgery, observation services, or lab tests, expect those to fall under Part B.

3. Most Prescription Drugs

Prescription medications you take at home are not covered by Part A. It may cover certain medications administered during an inpatient hospital stay, but once discharged, coverage for your prescriptions typically shifts to a separate prescription drug plan under Medicare Part D.

4. Dental, Vision, and Hearing

Routine dental care, eye exams for prescription glasses, and hearing aids are excluded. Even if you need these services due to a chronic condition or hospital stay, Part A does not cover them.

5. Overseas Medical Care

Care received outside the United States is not covered by Medicare Part A. If you travel internationally, you would need additional coverage to handle emergencies abroad.

The Role of Benefit Periods and Why They Matter

Part A coverage is based on benefit periods, not calendar years. A benefit period begins the day you’re admitted to a hospital or skilled nursing facility and ends when you haven’t received inpatient care for 60 consecutive days.

This structure can lead to multiple deductibles in one year. For example, if you’re hospitalized in January, discharged in February, and readmitted in April after 60 days, a new benefit period begins—and so does a new deductible.

Lifetime Reserve Days: Use with Caution

You have 60 lifetime reserve days available once you exceed 90 days in a hospital during a benefit period. These days can only be used once. After they’re exhausted, you pay all costs out of pocket for any future hospital stay beyond 90 days.

In 2025, using one of these reserve days will cost you $838 per day. If you require frequent long hospitalizations, these reserve days could be depleted faster than you expect.

What Happens Without Part B or Part D

While Part A covers the hospital, it’s not the full picture. If you don’t enroll in Medicare Part B (medical insurance) or Part D (drug coverage), you may face significant gaps in care:

• Without Part B: You won’t be covered for outpatient procedures, doctors’ visits, ambulance services, durable medical equipment, and preventive screenings.

• Without Part D: You’ll be paying out-of-pocket for most prescription drugs taken at home.

It’s also important to know that delaying enrollment in these parts can result in lifetime late enrollment penalties, unless you qualify for a Special Enrollment Period.

Medicare Part A and Hospice Care: What’s Included

Hospice care under Part A includes a range of support for terminally ill patients. This benefit covers:

• Pain relief and symptom management

• Grief counseling

• Support services for caregivers

However, it does not include treatments intended to cure the illness. You must agree to forgo curative treatment and be certified by a physician as having six months or less to live.

Hospice is provided in a variety of settings, including the home, a nursing facility, or a Medicare-certified hospice center. There may be small copayments for medications or respite care, but hospice services are largely covered.

Skilled Nursing Facility Coverage Limits

To receive coverage in a skilled nursing facility (SNF), you must first meet strict criteria:

• Have a qualifying hospital stay of at least three consecutive days as an inpatient

• Require daily skilled care

• Enter the SNF within 30 days of hospital discharge

Even with these criteria met, SNF coverage maxes out at 100 days. After that, you pay all costs out of pocket.

Preparing for the Gaps in Coverage

Given all that Medicare Part A excludes, how can you prepare?

• Consider Medicare Supplement Insurance (Medigap): While this article does not promote specific products, it’s worth exploring options that help pay your share of costs.

• Look into Part B and Part D: These are essential for covering outpatient care and prescriptions.

• Budget for non-covered services: Dental, vision, and long-term care may require separate planning or private insurance.

• Think about travel coverage: If you travel frequently, make sure you have a plan for international emergencies.

Don’t Overlook Enrollment Timelines

You generally become eligible for Medicare at age 65. Your Initial Enrollment Period (IEP) starts three months before your 65th birthday, includes your birthday month, and ends three months after. If you miss this window and don’t have other creditable coverage, you may face delays and penalties.

If you’re already receiving Social Security, you’re typically enrolled in Part A automatically. However, if not, it’s your responsibility to sign up through the Social Security Administration.

The Full Picture of Medicare Part A

While Medicare Part A is a vital component of your healthcare, it isn’t designed to cover everything. Understanding its limitations helps you avoid costly surprises and better prepare for the future. Many enrollees assume that hospital coverage means full coverage—but that isn’t the case.

To make sure you’re truly covered for what you need, speak with a licensed insurance agent listed on this website. They can walk you through your options and help you fill the gaps Part A leaves behind.