Key Takeaways

• Medicare Part A does not cover all hospital-related costs, and many enrollees only discover this after receiving an unexpected bill.

• You may face high out-of-pocket expenses if you rely solely on Part A, especially during extended hospital stays, skilled nursing facility care, or when services fall outside Medicare’s definition of “medically necessary.”

Understanding What Medicare Part A Actually Covers

Medicare Part A is often described as hospital insurance. That description, while technically true, can be misleading if you assume it means everything related to hospital care is covered. In reality, Part A covers:

• Inpatient hospital care (after being formally admitted)

• Limited skilled nursing facility care

• Hospice care

• Some home health services (following a qualifying hospital stay)

Coverage sounds reassuring on paper. But there are critical gaps, restrictions, and cost-sharing requirements that are not always clear until you face a real medical need.

The Admission Status Catch

One of the most common misunderstandings comes from confusion between inpatient and observation status. You are only covered under Part A if you’re officially admitted as an inpatient. If you are in the hospital for observation—even overnight or longer—your care is billed under Medicare Part B.

Why does this matter? Because observation status doesn’t count toward the three-day inpatient stay requirement that qualifies you for skilled nursing facility care under Part A. That means you could spend days in a hospital, then be denied Part A coverage for follow-up care.

The Three-Day Rule for Skilled Nursing Care

Medicare Part A covers skilled nursing facility (SNF) care—but only under strict conditions:

• You must have a qualifying three-day inpatient hospital stay, not including the discharge day.

• You must enter the SNF within 30 days of your hospital discharge.

• The SNF care must be for the same condition treated during your hospital stay.

If even one condition isn’t met, Medicare Part A won’t pay. And even when it does, it only covers up to 100 days—with full coverage for the first 20 days and daily coinsurance after that.

What Part A Leaves Out Completely

Many assume Medicare Part A is all-inclusive for hospital-related costs. But there are several key services that fall outside its scope:

• Private-duty nursing

• Television, telephone, or personal comfort items in a hospital room

• Long-term custodial care (non-medical assistance with bathing, eating, dressing)

• Outpatient care, even if it happens in a hospital setting

• Doctor’s services while in the hospital (these are billed under Part B)

Understanding what isn’t covered is just as important as knowing what is.

Out-of-Pocket Costs You’re Responsible For

Even when Medicare Part A does apply, you’re not shielded from out-of-pocket expenses. In 2025, these costs include:

• A $1,676 deductible per benefit period

• Coinsurance starting on day 61 of an inpatient stay: $419 per day from days 61–90

• Lifetime reserve days after day 90 (60 days total in your lifetime): $838 per day

• Skilled nursing coinsurance: $209.50 per day from days 21–100

These costs reset with each benefit period, defined as starting when you enter a hospital and ending when you’ve gone 60 days without inpatient or SNF care.

Lifetime Reserve Days Aren’t Unlimited

You only get 60 lifetime reserve days to use after day 90 of a single hospital stay. Once they’re gone, they don’t renew. If you exhaust them during one or more long stays, any future days beyond day 90 will come with the full hospital cost billed directly to you.

This feature surprises many people who think Medicare Part A will always be there during lengthy medical events. It won’t.

Hospital Transfers and Multiple Benefit Periods

If you are discharged from the hospital and then readmitted after more than 60 days, a new benefit period begins. That means:

• You pay the $1,676 deductible again.

• Day counts reset.

This can happen multiple times in a year, especially if you experience chronic or recurring conditions. The misconception that Medicare is “annual coverage” can lead to costly mistakes.

Limits on Home Health Coverage

Part A provides home health services only after a qualifying hospital stay and only if you’re homebound and require skilled care. Even then, it’s not indefinite. If your condition stabilizes or you only need help with daily activities rather than skilled nursing or therapy, coverage ends.

Additionally, some home health services fall under Part B, which means Part A alone doesn’t fully protect you.

Hospice Isn’t Just Unlimited Comfort Care

Medicare Part A covers hospice care for terminally ill patients who choose to forgo curative treatments. However, there are rules:

• You must be certified by a doctor to have a life expectancy of six months or less.

• You must receive care from a Medicare-approved hospice program.

• Coverage may exclude treatments aimed at curing the illness.

It also doesn’t cover room and board for hospice care in your home or custodial care if it’s the only type of care you need.

What Happens If You’re Not Automatically Enrolled

Not everyone is auto-enrolled in Medicare Part A at 65. If you’re not receiving Social Security or Railroad Retirement benefits at the time, you need to actively enroll during your Initial Enrollment Period (IEP). This period:

• Starts three months before your 65th birthday

• Includes your birthday month

• Ends three months after

Missing this window may delay coverage and result in late enrollment penalties if you don’t qualify for a Special Enrollment Period later.

Why Understanding Part A Isn’t Optional

Many people sign up for Medicare assuming they’re covered—and then only realize their exposure when they get a denial letter or a surprising bill. Medicare Part A isn’t a comprehensive hospital insurance plan. It’s a structured benefit with firm boundaries, cost-sharing requirements, and coverage limits.

Planning ahead is essential. You need to know how your status (inpatient vs. observation), length of stay, and specific needs impact your coverage.

Know the Fine Print Before You Rely on Part A

Don’t assume Medicare Part A will handle every hospital expense or long-term need. It’s crucial to read the fine print now—before a medical event forces you to learn it the hard way.

To review your full options or fill in the gaps Part A leaves behind, get in touch with a licensed insurance agent listed on this website. They can walk you through your situation and help you plan smarter.