Key Takeaways

• Medicare Part A may appear to offer wide-ranging hospital benefits, but the fine print reveals considerable gaps in coverage that could lead to unexpected out-of-pocket costs.

• Understanding how benefit periods, deductibles, and coinsurance work in 2025 is critical before you assume you’re fully protected during a hospital stay.

Part A Seems Generous—But Let’s Break It Down

When you first become eligible for Medicare, you might assume Part A takes care of all your hospital needs. After all, it’s often called “hospital insurance,” and for many people, it doesn’t even require a monthly premium. But once you’re actually admitted to a hospital, the story changes.

Part A is not designed to cover every hospital-related expense. Instead, it focuses on specific types of care within clearly defined timeframes and conditions. If you misunderstand these limits, you could end up facing thousands in unexpected costs.

What Part A Covers—But Only Under Certain Conditions

Medicare Part A covers the following services, but only if certain criteria are met:

• Inpatient hospital care (after formal admission by a doctor)

• Skilled nursing facility care (after a qualifying hospital stay)

• Home health care (when medically necessary and ordered by a physician)

• Hospice care (for terminally ill patients certified by a doctor)

While these benefits are real, they aren’t unlimited. Each comes with specific timelines, eligibility conditions, and out-of-pocket obligations.

The Deductible You Can’t Ignore

In 2025, the Medicare Part A deductible per benefit period is $1,676. This amount must be paid out-of-pocket before Medicare covers any inpatient hospital costs.

Importantly, this deductible isn’t annual. It resets with each benefit period, which starts the day you’re admitted to a hospital and ends after you’ve been out of the hospital (or skilled nursing facility) for 60 consecutive days.

That means you could face this deductible multiple times in a single year if you’re admitted for unrelated illnesses or have multiple hospitalizations spaced apart.

Your Stay Isn’t Free After the Deductible

Once you’ve paid your deductible, Medicare covers the cost of your hospital stay—but only up to a point.

Here’s what you’re responsible for in 2025:

• Days 1–60: $0 coinsurance (after deductible)

• Days 61–90: $419 per day

• Days 91–150: $838 per day (using your 60 lifetime reserve days)

• After 150 days: You pay 100% of the cost

Your hospital stay can become financially overwhelming if it extends beyond two months. Even with Medicare Part A, long hospitalizations are not fully covered.

Skilled Nursing Facility Coverage Isn’t Automatic

Many people assume that if they need rehabilitation or skilled nursing after a hospital stay, Medicare Part A will automatically cover it. But that’s not the case.

To qualify for skilled nursing facility (SNF) coverage under Part A:

• You must have a 3-day inpatient hospital stay (observation days don’t count)

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

• Your care must be medically necessary and require skilled nursing or therapy

If you qualify, here’s what Part A covers in 2025:

• Days 1–20: $0 per day

• Days 21–100: $209.50 per day

• After day 100: You pay the full cost

The SNF benefit is also tied to benefit periods. If you re-enter a facility outside of the 60-day window, a new benefit period (and new deductible) begins.

Observation Status Can Cost You

One of the most frustrating pitfalls with Part A involves hospital observation status. If you’re in a hospital but haven’t been officially admitted, Medicare considers you an outpatient—even if you stay overnight.

Being under observation means:

• Part A won’t cover the stay

• You’ll be billed under Part B (which has different cost-sharing rules)

• You may not qualify for SNF coverage afterward, even if your care required several days in the hospital

Always ask if you are officially admitted as an inpatient. It affects your financial responsibilities and eligibility for follow-up care.

Home Health Care Comes with Strict Rules

Medicare Part A does cover some home health care, but the circumstances are limited. To qualify:

• You must be homebound (leaving home is a considerable effort)

• A doctor must certify the care as medically necessary

• Services must be part-time or intermittent

If those conditions are met, Medicare will cover:

• Skilled nursing care

• Physical, occupational, or speech therapy

• Medical social services

But it will not cover:

• 24-hour home care

• Meals

• Homemaker services like cleaning or laundry

• Personal care unrelated to medical needs

Hospice Coverage Offers Strong Support—If You’re Eligible

Hospice is one area where Medicare Part A is often praised, as it covers nearly all costs associated with end-of-life care.

To be eligible for hospice:

• Your doctor must certify a life expectancy of 6 months or less

• You must choose palliative care over curative treatment

• You must sign a statement electing hospice care

Covered services include:

• Pain management and symptom control

• Medical and nursing services

• Social work and grief counseling

• Certain prescriptions and medical equipment

Even here, you might have small copayments for medications or respite care, but overall, hospice under Part A is extensive—as long as you meet the criteria.

What Part A Doesn’t Cover at All

It’s equally important to understand what Medicare Part A does not cover. These services require other parts of Medicare or separate insurance.

Not covered by Part A:

• Outpatient services (covered by Part B)

• Doctor visits (outside of inpatient settings)

• Prescription drugs outside of hospice (Part D)

• Routine dental, vision, or hearing care

• Long-term custodial care in nursing homes

Relying on Part A alone leaves large gaps in your healthcare safety net, especially for chronic or routine care needs.

Why You May Still Have Big Bills—Even with Part A

Even if you qualify for every benefit Part A offers, you could still face significant out-of-pocket costs. The reasons include:

• Multiple hospitalizations triggering multiple deductibles

• Long hospital stays leading to daily coinsurance

• Observation status disqualifying SNF coverage

• Home care limits excluding needed personal care

• No out-of-pocket maximum under Original Medicare

These expenses can stack up quickly, particularly if you face repeated or prolonged hospital care.

Medicare Isn’t One-Size-Fits-All—Know the Gaps

In 2025, Medicare continues to play a critical role in healthcare coverage for older adults, but it’s far from all-inclusive. Many of the benefits under Part A look robust on paper but have narrow eligibility criteria and time limits.

You need to be proactive in:

• Verifying your admission status

• Tracking benefit periods

• Understanding when deductibles reset

• Reviewing whether you meet SNF or home care conditions

Having this knowledge helps you avoid unpleasant surprises when you’re already dealing with health issues.

Be Prepared—Don’t Let Part A Surprise You

Part A provides vital support for hospital and inpatient care, but assuming it’s full coverage is a mistake that catches many people off guard. If you want to ensure your healthcare is truly protected, you’ll need a broader understanding of Medicare—and possibly additional coverage to fill the gaps.

To better understand your options and get help tailoring your coverage to your specific needs, speak with a licensed agent listed on this website. They can help you evaluate your situation and make informed decisions about your healthcare in retirement.