Key Takeaways

• Medicare Part A doesn’t cover everything—there are time-based limits, daily charges, and cost-sharing that many people overlook until it’s too late.

• Understanding coverage caps for hospital stays, skilled nursing facilities, and benefit periods can help you better plan for out-of-pocket costs in 2025.

What Medicare Part A Covers—And What It Doesn’t

Medicare Part A is often thought of as the go-to option for hospital care, and while that’s partially true, it’s far from complete coverage. In 2025, Part A continues to provide coverage for:

• Inpatient hospital care

• Skilled nursing facility care (after a qualifying hospital stay)

• Hospice care

• Limited home health services

However, Part A comes with strict rules and limitations that can leave you paying more than you expect.

The 2025 Deductible and Benefit Period Rules

One of the most misunderstood elements of Medicare Part A is how the deductible works. Unlike typical annual deductibles, Part A’s deductible applies per benefit period, not per calendar year. In 2025:

• The inpatient hospital deductible is $1,676 per benefit period.

• A benefit period begins the day you’re admitted to a hospital and ends after you haven’t received inpatient care for 60 days in a row.

• You could face multiple deductibles in one year if you’re hospitalized more than once with at least 60 days in between.

This structure often surprises beneficiaries who assume they only owe one deductible annually.

Daily Coinsurance Costs Can Add Up Fast

Medicare Part A also includes daily coinsurance amounts that kick in after you’ve been in the hospital for an extended stay. In 2025:

• Days 1-60: $0 coinsurance (after the deductible is met)

• Days 61-90: $419 per day

• Days 91-150 (lifetime reserve days): $838 per day

• Beyond day 150: You pay all costs

Lifetime reserve days are limited to 60 total days for your entire life. Once they’re used up, they’re gone for good. Long hospital stays can drain those quickly.

Skilled Nursing Facility Coverage Is Limited

Many assume that Medicare Part A will cover extended stays in a skilled nursing facility (SNF), but the reality in 2025 remains more limited than expected. You must meet strict criteria:

• You must have a qualifying hospital stay of at least three consecutive days (not including the discharge day).

• Admission to the SNF must occur within 30 days of leaving the hospital.

Once those criteria are met, coverage includes:

• Days 1-20: $0 coinsurance

• Days 21-100: $209.50 per day

• Day 101 and beyond: You pay all costs

So while you may get some relief in the short term, anything over 100 days comes out of your pocket.

Coverage for Hospice and Home Health Is Not Without Limits

Part A also covers hospice care and limited home health services, but both come with specific guidelines and caps:

• Hospice care requires a terminal illness diagnosis and certification by a doctor that you are likely to live six months or less. Coverage includes palliative care, not curative treatment.

• Home health care under Part A is only covered after a hospital stay and must be deemed medically necessary. You may be eligible for a limited number of visits, but not around-the-clock care.

These services help, but they aren’t substitutes for long-term care or full-time in-home assistance.

You Could End Up Paying More Than You Planned

In 2025, many people are still surprised when they find out that Medicare Part A doesn’t cover custodial care or long-term stays in a nursing home. This can be especially alarming if you assumed Medicare would help with all elder care needs. Here’s what you should know:

• Custodial care (help with bathing, eating, dressing) is not covered.

• Long-term nursing home stays are not covered under Part A.

• Care outside of a Medicare-certified facility may not be reimbursed.

You may need to look into other options for long-term care, such as Medicaid or private insurance, to fill the gaps Part A doesn’t address.

How Multiple Hospital Stays in a Year Affect Your Costs

Since the Part A deductible resets with each new benefit period, you could be responsible for paying it multiple times in a single year. For instance:

• Hospitalized in February: You pay the deductible.

• Discharged and out of inpatient care for 60+ days.

• Hospitalized again in July: You pay the deductible again.

This surprises many beneficiaries and creates unexpected out-of-pocket costs.

Lifetime Reserve Days: Use Them Wisely

Lifetime reserve days can offer additional coverage during very long hospital stays, but since you only get 60 of them in your lifetime, you need to think carefully before using them. Once they’re gone, they don’t replenish annually. Use them during medically necessary, unavoidable circumstances—not as a default extension of your stay.

What You Should Know About Hospital Observation Status

Sometimes you may stay in a hospital overnight but are classified as “under observation” rather than an inpatient. This has major implications:

• Observation status is covered under Part B, not Part A.

• Time under observation does not count toward the 3-day qualifying hospital stay for SNF coverage.

• This means you could be denied SNF coverage even if you were in a hospital bed for multiple nights.

Always clarify your status during a hospital visit. It can dramatically affect your benefits.

The Importance of Knowing Your Enrollment Status

Medicare enrollment isn’t automatic for everyone. If you’re not already receiving Social Security benefits when you turn 65, you need to enroll manually during your Initial Enrollment Period (IEP). Missing your IEP can lead to delayed coverage or even penalties.

• IEP begins three months before your 65th birthday and ends three months after.

• If you miss it, you may have to wait until the General Enrollment Period (January 1 to March 31), with coverage beginning in July.

Enrolling late doesn’t affect Part A costs for most people, but the delay in coverage could be risky if you have a sudden health event.

Planning for the Unexpected Is Critical

Part A’s limits make one thing clear: Medicare doesn’t provide blanket coverage. In 2025, as healthcare costs continue to rise, even one lengthy hospital stay could strain your finances if you’re not prepared.

Here are ways to reduce your exposure:

• Understand your benefit periods and coverage caps.

• Ask questions about your hospital status.

• Know how your SNF days are calculated.

• Consider supplementing Medicare with additional coverage to offset potential gaps.

Why These Gaps Still Surprise People

Every year, people run into the same issue—they assume Medicare covers more than it does. These surprises stem from common assumptions:

• Thinking Medicare is similar to traditional insurance.

• Believing all types of care are covered.

• Assuming one deductible covers the whole year.

• Not realizing how benefit periods or observation status work.

Knowing these details helps you plan smarter, avoid billing surprises, and get the care you need without added stress.

Be Proactive About Medicare Part A Limits

The more you know, the more empowered you are to make smart healthcare choices. Medicare Part A offers essential benefits, but you need to understand its restrictions to avoid high, unexpected costs. Always review your options carefully, and for professional advice tailored to your needs, speak with a licensed agent listed on this website.