Key Takeaways
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Medicare Part A isn’t automatically free for everyone. Your eligibility and work history determine whether you pay a premium.
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Even if you’re eligible for premium-free Part A, you can still face high out-of-pocket costs like deductibles and coinsurance.
What Medicare Part A Covers (And What It Doesn’t)
Medicare Part A, also known as hospital insurance, is one of the foundational components of Medicare. In 2025, it covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. But despite its name, Part A does not cover everything you might associate with hospital or medical care.
Here’s what Medicare Part A includes:
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Inpatient care in a hospital after you are formally admitted
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Skilled nursing facility care (but only after a qualifying hospital stay of at least 3 days)
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Limited home health services
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Hospice care for terminally ill individuals who meet specific eligibility criteria
What’s not covered under Part A:
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Doctor services (those are billed under Part B)
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Outpatient hospital services
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Prescription drugs (outside of those administered during inpatient stays)
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Long-term custodial care
Many people assume Part A covers all hospital-related expenses. It does not. You still have to pay deductibles, coinsurance, and possibly premiums—depending on your work history.
Premiums Aren’t Always Avoidable
While some people qualify for premium-free Medicare Part A, that’s not guaranteed for everyone. As of 2025, you are eligible for premium-free Part A if you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years).
If you worked fewer than 30 quarters, you pay the full premium, which is $518 per month in 2025. If you worked between 30 and 39 quarters, your monthly premium is $284.
These amounts are set by the federal government and updated annually. This means that individuals who didn’t have long enough work histories or who immigrated to the U.S. later in life may face substantial monthly costs just for Part A.
The 2025 Deductible Is Higher Than You Might Expect
In 2025, the inpatient hospital deductible under Medicare Part A is $1,676 per benefit period—not per year. A benefit period begins the day you’re admitted to a hospital and ends after you’ve been out for 60 consecutive days. This means you could pay the deductible multiple times in one year if you’re hospitalized more than once.
After you’ve paid the deductible, your cost-sharing doesn’t end:
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Days 1–60 of hospitalization: $0 coinsurance per day (after deductible)
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Days 61–90: $419 per day
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Days 91 and beyond: $838 per day (using your lifetime reserve days)
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Beyond lifetime reserve days: You pay all costs
So even though Part A helps reduce the cost of hospital care, it certainly doesn’t eliminate it. These charges can add up quickly during extended or repeat hospital stays.
Skilled Nursing Facility Coverage Has Strings Attached
Many people are surprised to learn that Medicare Part A will only cover skilled nursing facility (SNF) care if specific conditions are met:
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You must have a prior inpatient hospital stay of at least 3 consecutive days.
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You must enter the SNF within 30 days of your hospital discharge.
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Your care must be related to the condition treated during your hospital stay.
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The SNF must be Medicare-certified.
When these conditions are met, you’re covered as follows in 2025:
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Days 1–20: No coinsurance
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Days 21–100: $209.50 per day
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Beyond 100 days: You pay all costs
This means Part A is designed for short-term recovery, not long-term stays. If you need custodial or residential care long-term, Part A won’t help.
Hospice Care: Covered, But Not Without Limits
Hospice services under Part A include pain management, symptom control, and support for terminally ill individuals who are expected to live six months or less.
To qualify for hospice under Medicare Part A:
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A doctor must certify your terminal illness.
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You must agree to forgo curative treatments.
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You must receive care from a Medicare-approved hospice provider.
Medicare covers most hospice-related costs, including medications related to your terminal condition, nursing care, and spiritual counseling. But there may still be some copayments, like:
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Up to $5 for each prescription drug
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5% of the Medicare-approved amount for respite care
Hospice is one of the more comprehensive services within Part A, but again, it’s not entirely without cost.
Home Health Services: Only If You Qualify
Medicare Part A offers limited home health benefits when:
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You are homebound (meaning leaving home is medically difficult)
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You need intermittent skilled nursing care, physical therapy, or speech-language pathology
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You have a plan of care certified by a physician
There is no cost for covered home health services under Part A. However, durable medical equipment (DME), like wheelchairs or walkers, typically falls under Part B and may come with separate costs.
What Happens If You Delay Part A Enrollment?
If you’re eligible for premium-free Part A, you can enroll anytime after your Initial Enrollment Period (IEP), and your coverage can start retroactively for up to six months. But if you have to pay a premium and miss your IEP, you may face a late enrollment penalty.
Your Initial Enrollment Period spans seven months:
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Three months before your 65th birthday
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The month you turn 65
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Three months after
If you miss this window and don’t qualify for a Special Enrollment Period (SEP), you’ll have to wait for the General Enrollment Period (January 1 to March 31) and your coverage will begin July 1. More importantly, you may face a 10% penalty on your monthly premium for twice the number of years you were eligible but didn’t sign up.
That penalty can stick with you for life.
Who Might Not Need Part A Right Away?
If you’re still working and have group health insurance through your employer (or your spouse’s), you might not need to enroll in Part A immediately—especially if you have a Health Savings Account (HSA).
Enrolling in any part of Medicare disqualifies you from contributing to an HSA. If you plan to keep contributing, you may want to delay Part A—assuming you’re not getting it premium-free. Once you stop working or lose your group coverage, you’ll get an 8-month Special Enrollment Period to sign up without penalty.
Why You Still Need to Think About Part B and Part D
Even if you’re focused on understanding Part A, don’t forget about the other parts of Medicare. Most medical services, including doctor visits and outpatient care, fall under Part B. Prescription drugs are generally covered under Part D or other drug plans.
You need to coordinate all parts of Medicare for complete coverage. Relying on Part A alone could leave you exposed to high costs and denied claims.
Planning Your Medicare Strategy Starts With Understanding Part A
Medicare isn’t one-size-fits-all. And the belief that Part A is free and covers everything leads many people into financial surprises. From premium costs to strict eligibility rules for skilled nursing, knowing what Part A does—and doesn’t—cover can make the difference between peace of mind and unexpected bills.
If you’re unsure about your eligibility, premium obligations, or how Part A works with your current healthcare plan, it’s a good idea to speak with a licensed insurance agent listed on this website. They can help you assess your situation and develop a Medicare plan that aligns with your needs and timeline.
