Key Takeaways
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Medicare Part A provides essential hospital coverage, but its limitations can lead to significant out-of-pocket costs if you’re not prepared.
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It doesn’t cover long-term care, most prescription drugs, or routine medical services, making supplemental coverage or strategic planning essential.
What Medicare Part A Promises to Cover
Medicare Part A is often referred to as hospital insurance. It’s the part of Original Medicare that helps pay for inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health services. On paper, it sounds like a strong foundation for your healthcare needs. But once you look closer, you’ll see that it leaves critical gaps that can quickly affect your finances and well-being if you don’t have a plan to fill them.
Hospital Inpatient Care
You’re covered for hospital stays when you are formally admitted to a hospital. Part A pays for:
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A semi-private room
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Meals during your hospital stay
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General nursing services
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Medications and supplies used while you’re admitted
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Operating room and recovery services
In 2025, the Part A deductible is $1,676 per benefit period. A benefit period starts when you’re admitted and ends after 60 consecutive days without inpatient care. You’re responsible for additional daily coinsurance if your stay exceeds 60 days:
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Days 1–60: $0 coinsurance after deductible (but remember, you already paid $1,676 upfront)
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Days 61–90: $419 per day
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Days 91–150 (using lifetime reserve days): $838 per day
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After 150 days: You pay all costs
Skilled Nursing Facility (SNF) Care
Part A also helps cover a limited stay in a skilled nursing facility—but only under specific conditions:
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You must have a qualifying inpatient hospital stay of at least 3 consecutive days
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The SNF stay must begin within 30 days of your hospital discharge
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You must need daily skilled care related to your hospital treatment
Coverage includes:
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Semi-private room
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Meals
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Skilled nursing care
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Physical, occupational, and speech therapy
Here’s the cost breakdown for SNF care in 2025:
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Days 1–20: $0
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Days 21–100: $209.50 per day
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After day 100: You pay all costs
Hospice Care
If your doctor certifies you have a terminal illness with a life expectancy of six months or less, Part A pays for hospice care. Services include pain management, support services, and certain drugs. Room and board are not covered unless you’re in a Medicare-approved hospice facility.
Home Health Services
Medicare Part A can also cover part-time or intermittent skilled nursing care at home, physical therapy, or other services—but only under a doctor’s orders. You must be homebound and require skilled care. Custodial care, like help with bathing or dressing, is not covered unless it’s part of the skilled care treatment.
What Medicare Part A Doesn’t Cover
Now let’s explore the substantial gaps that often surprise enrollees. These are the areas where people assume they’re covered but are not.
Long-Term Custodial Care
One of the most misunderstood exclusions in Part A is long-term care, also known as custodial care. This refers to assistance with everyday activities such as:
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Bathing
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Dressing
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Eating
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Using the bathroom
Whether it’s in a nursing home, assisted living facility, or in your own home, Medicare does not pay for long-term custodial care unless it coincides with covered skilled services—and only for a limited time. This can become a massive financial burden, especially since the average cost of long-term care can run into thousands of dollars monthly.
Outpatient Services and Doctor Visits
Part A strictly covers inpatient services. Any visit to a doctor, even one that happens in a hospital setting but is billed separately, is not covered by Part A. These fall under Medicare Part B. That includes:
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Routine physical exams
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Specialist consultations
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Diagnostic imaging and lab tests
Most Prescription Medications
Prescription drugs you take at home are not covered under Part A. Only medications administered during a hospital or hospice stay are included. You’ll need separate drug coverage, typically through Medicare Part D, to get help paying for regular prescriptions.
Dental, Vision, and Hearing Care
Medicare Part A does not cover:
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Routine dental care (cleanings, fillings, dentures)
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Vision care (eye exams for glasses, refraction tests)
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Hearing exams or hearing aids
You’ll need to consider additional coverage if these are important to your health needs.
Private-Duty Nursing and Personal Aides
If you want a personal nurse to assist you in a hospital or at home, that’s not something Part A will pay for. Private-duty nursing and personal aides who help with non-medical tasks are excluded, even during recovery periods unless part of a qualifying skilled care plan.
Blood Transfusions (Beyond the First 3 Pints)
You pay for the first three pints of blood you receive in a calendar year unless the hospital gets the blood free from a donation. After that, Part A may cover additional units during inpatient care.
The Timelines That Matter
Understanding Part A is only part of the picture—you also need to pay close attention to enrollment timelines. Missing deadlines can result in penalties or delayed coverage.
Initial Enrollment Period (IEP)
This is your first chance to enroll in Medicare. It starts three months before the month you turn 65, includes your birthday month, and ends three months after. If you’re already receiving Social Security, you’re typically enrolled in Part A automatically.
Special Enrollment Period (SEP)
You may qualify for a Special Enrollment Period if you delayed enrollment due to having employer group coverage. Once that coverage ends, you have eight months to enroll in Part A without facing a late enrollment penalty.
General Enrollment Period (GEP)
If you missed both IEP and SEP, the General Enrollment Period runs from January 1 to March 31 each year. However, your coverage won’t start until July 1, and you may face a permanent premium penalty if you’re not eligible for premium-free Part A.
Planning Around Part A’s Gaps
Understanding what Part A doesn’t cover helps you make informed choices. Here are practical steps to consider:
Add Part B Coverage
Part B covers outpatient care, preventive services, and doctors’ visits. You’ll need it for services beyond hospital stays.
Consider Prescription Drug Coverage
Enroll in Medicare Part D to help cover prescription medications. This is especially important if you regularly take medications that Part A doesn’t include.
Evaluate Supplemental Coverage
Some people explore supplemental insurance options to cover deductibles, coinsurance, and services not covered by Original Medicare. You’ll need to weigh costs and benefits carefully.
Prepare for Long-Term Care
Since Medicare doesn’t cover long-term custodial care, explore other ways to prepare:
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Long-term care insurance
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Medicaid (if you qualify)
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Personal savings or assets set aside for care
When Part A Isn’t Enough—Take the Next Step
It’s easy to assume that Medicare Part A will take care of all your major health expenses, but that assumption can leave you vulnerable. Hospital care is only one piece of the healthcare puzzle. Understanding what isn’t included—like long-term care, outpatient services, and prescriptions—is just as critical as knowing what is.
If you’re turning 65 soon or reviewing your current Medicare coverage, don’t stop at Part A. Get personalized help by speaking with a licensed agent listed on this website to understand how to close the gaps. A single conversation can lead to a better, more affordable long-term plan.
