Key Takeaways

• Medicare Part A does cover hospital-related care, but the definition of “hospital care” is narrower than you might expect.

• Several essential services—like long-term custodial care, routine dental work, and prescription drugs outside of hospital settings—are not covered under Part A, potentially leading to high out-of-pocket costs.

What Medicare Part A Includes—At First Glance

Medicare Part A, often referred to as hospital insurance, is one of the core components of Original Medicare. If you’re 65 or older and qualify based on your work history or your spouse’s, you’re likely eligible for premium-free Part A. But free doesn’t always mean fully covered.

Part A helps cover your inpatient care, but its benefits are tied to specific types of facilities and care situations. Here’s what it currently includes in 2025:

Inpatient Hospital Care

You’re covered when you’re formally admitted to a hospital that accepts Medicare. Coverage applies to:

• Semi-private rooms

• Meals

• General nursing

• Drugs administered as part of inpatient treatment

• Other hospital services and supplies

Coverage does not include private-duty nursing, personal comfort items, or a private room (unless medically necessary).

Skilled Nursing Facility (SNF) Care

If you need further care after a hospital stay, Medicare Part A may cover up to 100 days in a skilled nursing facility (SNF)—but only if:

• You had a qualifying hospital stay of at least three consecutive days

• You need daily skilled services

• The SNF is Medicare-certified

The cost-sharing structure:

• Days 1–20: Fully covered by Medicare

• Days 21–100: You pay a daily coinsurance

• After day 100: You pay all costs

Home Health Care (Limited)

When prescribed by a doctor and deemed medically necessary, Part A may cover limited home health services, such as:

• Part-time skilled nursing care

• Physical therapy

• Speech-language pathology

However, this doesn’t include 24-hour care, meals delivered to your home, or help with daily tasks unless skilled services are also being provided.

Hospice Care

Part A covers hospice care for individuals certified as terminally ill (life expectancy of six months or less). Services include:

• Pain relief and symptom management

• Home health aide services

• Medical equipment

• Short-term inpatient respite care

Hospice under Part A allows for dignity and comfort but not curative treatments.

Inpatient Mental Health Care

You’re covered for mental health treatment in a general or psychiatric hospital. There is, however, a lifetime limit of 190 days in a psychiatric hospital.

The Many Services Medicare Part A Doesn’t Cover

Despite the support Part A offers during hospital stays, many necessary healthcare services are excluded. Here’s a breakdown of what you can’t rely on Medicare Part A to pay for.

1. Long-Term Custodial Care

One of the biggest misconceptions is that Medicare pays for long-term care. It does not. Custodial care—which includes assistance with activities like bathing, dressing, and eating—is not covered if it’s the only care you need. This includes care in nursing homes or assisted living facilities unless skilled nursing is also involved and meets Medicare’s conditions.

2. Outpatient Services

Part A does not cover outpatient care, including:

• Doctor visits

• Diagnostic tests

• Emergency room visits (unless resulting in admission)

• Outpatient surgeries

These fall under Medicare Part B, which you must enroll in separately.

3. Prescription Drugs (Outside of Hospital Settings)

While drugs administered during an inpatient hospital stay are covered, any medications you take at home—whether short-term or chronic—are not covered under Part A. You would need a separate prescription drug plan (Part D) or other coverage.

4. Routine Dental, Vision, and Hearing Care

These services are essential to daily well-being, but Part A does not include:

• Routine dental exams, cleanings, or dentures

• Eye exams for glasses

• Hearing exams or hearing aids

If you need these services regularly, expect to pay out of pocket or explore additional coverage options.

5. Non-Medical Home Care

In 2025, more older adults are aging in place, but Medicare Part A does not pay for non-medical in-home support. This includes help with:

• Meal preparation

• Housekeeping

• Transportation

Unless these are part of a medically necessary, doctor-ordered plan that includes skilled services, you’re responsible for the cost.

6. Blood (Beyond the First Three Pints)

If you receive a blood transfusion during an inpatient hospital stay, you must pay for the first three pints unless the hospital gets it free from a blood bank. After that, Part A covers additional units.

7. Foreign Travel Healthcare

With rare exceptions, Medicare Part A does not cover care received outside the United States. Emergency treatment abroad is generally not reimbursed, even if it would otherwise be covered domestically.

Cost-Sharing in Part A: Deductibles and Coinsurance

Even if a service is covered, you still face deductibles and coinsurance:

• Inpatient hospital deductible: In 2025, you pay $1,676 per benefit period

• Hospital stay coinsurance:

  • Days 1–60: $0 coinsurance

  • Days 61–90: $419 per day

  • Days 91–120: $838 per day (lifetime reserve days)

  • After day 120: All costs

Understanding benefit periods is key. A new benefit period begins after 60 days without inpatient care, resetting your deductible.

What You Can Do to Fill the Gaps

Given these significant gaps, most people don’t rely solely on Medicare Part A. Here are ways you can protect yourself:

• Enroll in Medicare Part B: Covers outpatient services, doctors, preventive care

• Consider Medicare Part D: Adds drug coverage

• Look into supplemental insurance: Often called Medigap, helps cover deductibles and coinsurance

• Evaluate Medicare Advantage plans: Though offered by private companies, these bundle Part A, B, and often D with extra benefits

Be sure to compare plan features carefully and review annual changes. It’s also wise to reassess your health needs during Medicare Open Enrollment from October 15 to December 7 each year.

How Eligibility and Enrollment Timing Affect Access

Eligibility for premium-free Part A generally comes from earning 40 quarters (10 years) of Medicare-covered employment. If you or your spouse don’t meet this requirement, you’ll pay a monthly premium—up to $518 in 2025.

Initial Enrollment Period (IEP):

• Begins 3 months before your 65th birthday

• Includes your birth month

• Ends 3 months after your birth month

Delaying enrollment may trigger late penalties unless you have qualifying employer coverage. Missing these deadlines could mean waiting until the next General Enrollment Period (January 1–March 31) and having coverage start in July.

Understanding Your Coverage Helps You Avoid Surprises

Medicare Part A can be a helpful foundation, but it was never designed to cover everything. When you understand its limits—especially regarding long-term care, routine outpatient needs, and prescription drugs—you’re in a better position to plan and avoid costly surprises.

If you’re approaching Medicare eligibility or are already enrolled, now is the time to assess whether you have the coverage you need. You may need to make additional decisions about Part B, Part D, or other insurance to stay fully protected.

Plan Beyond the Basics of Medicare Part A

You deserve peace of mind when it comes to your healthcare—especially in retirement. While Medicare Part A takes care of many hospital-related expenses, it leaves out major categories that can result in financial stress if you’re not prepared. Understanding what’s included—and more importantly, what isn’t—empowers you to make informed decisions.

For personal guidance tailored to your situation, consider getting in touch with a licensed agent listed on this website who can help walk you through your options and find the right combination of Medicare coverage.