Key Takeaways
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Medicare Part A covers hospital stays, but it does not include everything you might assume comes with inpatient care—there are critical gaps in coverage that can lead to significant out-of-pocket expenses.
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Understanding what Part A excludes—such as long-term custodial care, outpatient services, and certain deductibles—can help you plan better and explore additional coverage options.
What Medicare Part A Actually Covers
Medicare Part A is often referred to as hospital insurance. It is part of Original Medicare and automatically covers most people who are 65 or older and eligible for Social Security benefits. In 2025, if you or your spouse paid Medicare taxes for at least 10 years, you likely qualify for premium-free Part A.
Covered services under Part A include:
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Inpatient hospital stays
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Skilled nursing facility care (short-term, after a hospital stay)
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Hospice care
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Limited home health care
While this list may sound reassuring, it is crucial to understand what is not included, and where you might be responsible for out-of-pocket costs.
1. You Still Pay a Deductible for Hospital Stays
Even though Part A is often described as premium-free, that doesn’t mean it’s cost-free. In 2025, you must pay a deductible of $1,676 for each benefit period when admitted to a hospital. A benefit period begins when you’re admitted and ends when you haven’t received inpatient hospital or skilled nursing care for 60 consecutive days.
If you’re hospitalized multiple times in a year and the benefit periods don’t overlap, you may need to pay this deductible more than once.
2. Coverage Limits on Hospital Days
Medicare Part A doesn’t cover indefinite hospital stays. In 2025, you receive:
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Full coverage for days 1–60
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Coinsurance of $419 per day for days 61–90
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Coinsurance of $838 per day for lifetime reserve days (up to 60 days over your lifetime)
Once you’ve used all your lifetime reserve days, you are responsible for 100% of the costs for additional days. This can be financially devastating if you require long-term hospitalization.
3. Skilled Nursing Isn’t the Same as Long-Term Care
Part A covers skilled nursing facility care only under specific conditions:
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You must have had a qualifying inpatient hospital stay of at least 3 days.
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The skilled nursing care must begin within 30 days of leaving the hospital.
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The care must be medically necessary and provided by a Medicare-certified facility.
In 2025, you receive:
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Full coverage for the first 20 days
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$209.50 per day in coinsurance for days 21–100
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No coverage beyond 100 days
What it doesn’t cover is custodial care, such as assistance with bathing, dressing, or eating—services commonly required in nursing homes. That’s where many people mistakenly assume Medicare will step in, and it doesn’t.
4. It Leaves Out Outpatient and Doctor Services
If you’re receiving hospital care but your doctor bills separately for services or if you get outpatient tests during your stay, Medicare Part A won’t cover these costs. That falls under Medicare Part B.
Examples include:
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Physician services during inpatient care
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Outpatient surgery
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Lab tests or scans during observation stays
Observation status is particularly tricky. If you are in a hospital under observation (even if you stay overnight), it is billed as outpatient care. That means Medicare Part A does not cover the stay.
5. Home Health Benefits Are Very Limited
While Medicare Part A includes some home health services, these are only provided under narrow circumstances:
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You must be homebound.
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Care must be part-time or intermittent.
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You need skilled services (e.g., nursing care or physical therapy).
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The services must be ordered by a doctor and provided by a Medicare-certified agency.
Routine, non-skilled care—such as help with meals, laundry, or cleaning—is not covered.
6. Hospice Comes with Conditions
Part A covers hospice care, but only when you meet all of these conditions:
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Your doctor certifies that you are terminally ill with a life expectancy of six months or less.
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You agree to give up curative treatments.
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You receive care from a Medicare-approved hospice provider.
Even within hospice coverage, Medicare doesn’t pay for room and board if you receive hospice care at home or in a nursing facility. You might also be responsible for a small copayment (up to $5 per prescription) and a 5% charge for inpatient respite care.
7. There’s No Out-of-Pocket Maximum
Unlike many private insurance plans, Medicare Part A has no annual out-of-pocket maximum. This means there’s no cap on how much you might pay in a year if you have multiple hospitalizations, use skilled nursing services, or need extended care.
This is one of the most significant financial risks for anyone relying on Medicare Part A alone.
8. It Doesn’t Cover Emergency Services Abroad
If you travel outside the U.S., Medicare Part A generally doesn’t cover emergency or inpatient hospital care. There are a few rare exceptions, such as:
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If a foreign hospital is closer than a U.S. one in case of an emergency
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If you’re traveling through Canada between Alaska and another state and an emergency occurs
Even in those cases, documentation and strict criteria apply.
9. Mental Health Inpatient Care Is Capped
Medicare Part A does cover inpatient mental health services in a general hospital or a psychiatric hospital. However, there is a lifetime limit of 190 days if you are treated in a psychiatric hospital. If you require care beyond that, it must be provided in a general hospital to be covered.
10. What You Can Do to Fill the Gaps
Because Medicare Part A doesn’t offer full coverage, it’s common to look for ways to manage these gaps:
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Enroll in Medicare Part B for outpatient care, doctor visits, preventive screenings, and durable medical equipment.
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Consider a Medicare Supplement Insurance plan (also known as Medigap), which helps pay for deductibles, coinsurance, and copayments.
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Evaluate Medicare Part D for prescription drug coverage.
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Review your options during the Medicare Open Enrollment Period (October 15 to December 7 annually) to ensure your coverage meets your needs.
These steps can help prevent unexpected costs and ensure broader coverage across both inpatient and outpatient services.
Gaps in Medicare Part A Could Lead to Expensive Surprises
Medicare Part A offers foundational coverage for hospital-related services, but it’s not a blanket solution for all your health needs. From deductibles and daily coinsurance to its lack of long-term custodial care and no out-of-pocket limit, the gaps are substantial.
Understanding what is and isn’t included helps you make better choices about your healthcare. If you’re approaching 65 or are already enrolled, now is the time to evaluate what additional coverage you may need. To explore the right options for your specific situation, connect with a licensed insurance agent listed on this website.
