Key Takeaways
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Medicare Part A covers hospital stays, but it doesn’t include everything you might expect—like long-term care, outpatient services, or many common follow-up needs.
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Understanding what Medicare Part A leaves out can help you plan for unexpected costs and explore the right coverage options to fill those gaps.
What Medicare Part A Covers in 2025
At first glance, Medicare Part A appears straightforward: it’s the part of Original Medicare that covers hospital insurance. You’re typically eligible for it at age 65 if you or your spouse paid Medicare taxes for at least 10 years. For most people, it comes without a premium, though that doesn’t mean it’s without cost.
Here’s what Medicare Part A covers in 2025:
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Inpatient hospital care: Room, meals, nursing services, and some medications while you’re formally admitted to a hospital.
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Skilled nursing facility (SNF) care: Short-term rehabilitation following a hospital stay, with strict eligibility requirements.
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Home health care: Intermittent skilled nursing care, physical therapy, and other services—only if you meet specific criteria.
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Hospice care: End-of-life care for terminally ill patients, often in the home.
While these services are essential, the gaps in what Medicare Part A does not cover can leave you with significant out-of-pocket expenses if you’re unprepared.
What Part A Leaves Out That Might Surprise You
Many people assume that anything involving a hospital or health recovery will fall under Part A. But that assumption often leads to unpleasant financial surprises. Below are key services and situations that are not covered under Medicare Part A in 2025:
Custodial or Long-Term Care
Medicare Part A does not cover long-term stays in a nursing home or custodial care (such as help with bathing, dressing, or eating) if it’s the only care you need. Even if you’re in a skilled nursing facility, once your medical condition stabilizes, coverage ends.
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No coverage for assisted living or residential care facilities.
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No coverage for long-term custodial care at home.
Emergency Room Visits Without Admission
If you go to the emergency room but aren’t admitted to the hospital (even if you stay overnight for observation), Part A doesn’t apply. Instead, Medicare Part B would handle those services—but with its own costs and limitations.
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Observation stays do not count toward the three-day requirement for SNF coverage.
Outpatient Surgeries and Services
Even if performed in a hospital, outpatient surgeries are not covered by Part A. These include:
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Cataract removal
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Colonoscopies
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Minor orthopedic procedures
These fall under Part B, meaning you could be responsible for deductibles, copayments, and coinsurance.
Personal Comfort Items and Private Rooms
If you’re admitted to the hospital, Medicare Part A will cover a semiprivate room. But if you request a private room or items such as a TV or telephone, you’ll pay out of pocket unless medically necessary.
Foreign Hospital Care
Except in extremely limited cases, Medicare Part A doesn’t cover medical services outside the United States or its territories.
Costs You’re Still Responsible For Under Part A
Even the services Medicare Part A does cover aren’t free. For 2025, you should prepare for the following out-of-pocket expenses:
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Inpatient hospital deductible: $1,676 per benefit period.
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Coinsurance for hospital stays:
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Days 1–60: $0 (after deductible)
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Days 61–90: $419 per day
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Days 91–150: $838 per day (lifetime reserve days)
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After 150 days: You pay all costs
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Skilled Nursing Facility care:
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Days 1–20: $0
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Days 21–100: $209.50 per day
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After 100 days: You pay all costs
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A “benefit period” begins the day you’re admitted and ends after you’ve been out of the hospital or skilled care for 60 days in a row. There’s no limit to the number of benefit periods in a year, so these costs can add up quickly.
When Other Parts of Medicare Take Over
Because Part A leaves many gaps, you’ll often rely on other parts of Medicare to complete your coverage:
Medicare Part B
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Covers outpatient care, doctor visits, preventive services, lab work, and durable medical equipment.
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Includes a monthly premium ($185 in 2025) and an annual deductible ($257).
Medicare Part D
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Offers prescription drug coverage, which Part A doesn’t include.
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In 2025, the annual deductible is capped at $590.
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There is now a $2,000 out-of-pocket maximum for the year, a significant improvement over past coverage gaps.
Supplemental Coverage Options
If you only have Original Medicare (Parts A and B), you’re likely to face high out-of-pocket costs. Many people choose to:
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Enroll in a Medigap (Medicare Supplement) plan to help pay for deductibles and coinsurance.
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Choose a Medicare Advantage plan, which may include hospital, medical, and drug coverage in one plan. Note: costs and benefits vary widely.
Timing Matters More Than You Think
Understanding when you enroll in Medicare Part A is just as important as knowing what it covers.
Initial Enrollment Period (IEP)
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When: Starts 3 months before the month you turn 65, includes your birth month, and ends 3 months after (7 months total).
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Tip: Enroll early to avoid gaps in coverage.
Special Enrollment Period (SEP)
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For those still working: You can delay Part A (and Part B) if you have employer coverage.
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After leaving a job: You have 8 months to enroll without penalty.
General Enrollment Period (GEP)
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When: January 1 to March 31 each year.
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Coverage starts: The month after you enroll.
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Downside: You may face late penalties if you missed your IEP and don’t qualify for a SEP.
Missing these windows could lead to delayed coverage and lifetime penalties, particularly for Part B—but it affects your whole Medicare setup.
How to Plan Ahead for What Part A Doesn’t Cover
To reduce future costs and coverage gaps, consider these strategies:
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Review your total expected healthcare needs each year—not just hospital stays.
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Compare supplemental coverage options during the Annual Enrollment Period (October 15–December 7).
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Confirm provider acceptance: Not all doctors or facilities accept Medicare.
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Track your benefit periods if you’re in and out of the hospital.
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Build a healthcare savings buffer for unexpected costs like skilled nursing copays or long hospital stays.
Being Prepared for the Limits of Hospital Coverage
Medicare Part A forms the foundation of your coverage, but it isn’t enough by itself. Understanding where the coverage ends is essential for protecting yourself financially in 2025 and beyond. Whether it’s planning for outpatient procedures, long-term care needs, or unexpected coinsurance, you’ll need more than just Part A to feel secure.
Speak with a licensed agent listed on this website to evaluate your full coverage options and receive expert help customizing your Medicare plan to your needs.
