Key Takeaways

• Medicare Part A covers hospital stays, skilled nursing care, hospice, and some home health services, but it doesn’t cover everything—you could still face significant out-of-pocket costs.

• Understanding deductibles, coinsurance, and coverage gaps is crucial to avoiding surprise medical bills and ensuring you have the right coverage for your needs.

Medicare Part A: What It Covers and Where It Falls Short

Medicare Part A is often referred to as “hospital insurance,” and while it does cover essential healthcare services, many people mistakenly believe it pays for everything. That’s not the case. Even if you qualify for premium-free Part A, you still need to understand its limits and potential out-of-pocket expenses. Without proper planning, you could be left paying thousands of dollars for care that isn’t fully covered.

The Basics of Medicare Part A Coverage

Medicare Part A is designed to cover inpatient hospital stays, but it also includes some additional benefits. Here’s what it typically covers:

Hospital Stays

• Semi-private room, meals, and general nursing care

• Medications administered during inpatient treatment

• Operating room and recovery services

• Certain inpatient diagnostic tests and treatments

Skilled Nursing Facility (SNF) Care

• Short-term rehabilitation after a hospital stay

• Physical, occupational, and speech therapy

• Medications and medical equipment during your stay

Home Health Care

• Limited part-time or intermittent skilled nursing care

• Physical therapy and other rehabilitative services

Hospice Care

• End-of-life care for terminally ill patients

• Medications and services to manage pain and symptoms

The Costs You’ll Still Have to Pay

Even though Medicare Part A helps cover major healthcare expenses, it doesn’t pay for everything. You’ll still have to pay certain costs, including:

Deductibles and Coinsurance

• In 2025, the Medicare Part A deductible is $1,676 per benefit period. You pay this amount before Medicare starts covering hospital costs.

• If your hospital stay exceeds 60 days, you’ll pay $419 per day from days 61-90.

• If you stay beyond 90 days, you enter your “lifetime reserve days,” which cost $838 per day—and you only have 60 lifetime reserve days total.

• Skilled nursing care is free for the first 20 days, but after that, you’ll owe $209.50 per day for days 21-100.

What Medicare Part A Does Not Cover

Medicare Part A leaves some significant gaps in coverage, including:

• Long-term custodial care (like nursing home stays beyond skilled nursing care)

• Routine vision, dental, and hearing services

• Private hospital rooms (unless medically necessary)

• Personal care assistance if it is not considered skilled nursing care

• Prescription drugs outside of inpatient settings

How These Gaps Could Lead to Unexpected Bills

Many people assume Medicare will cover all hospital-related costs, but these coverage gaps can result in thousands of dollars in expenses. If you require a long hospital stay or extensive skilled nursing care, your out-of-pocket costs can add up quickly.

Example Cost Breakdown for a Long Hospital Stay

If you stay in the hospital for 100 days, here’s what you’d pay in 2025:

• Days 1-60: $1,676 deductible

• Days 61-90: $419 per day x 30 days = $12,570

• Days 91-100: $838 per day x 10 days = $8,380 (using lifetime reserve days)

• Total Out-of-Pocket Cost: $22,626

This doesn’t even include additional expenses like outpatient follow-up care, prescription drugs, or home health services, which aren’t fully covered under Part A.

How to Protect Yourself from Coverage Gaps

Because Medicare Part A doesn’t cover everything, you need to plan ahead to avoid financial surprises. Here are some ways to protect yourself:

Know Your Enrollment Options

Understanding when and how to enroll in Medicare is crucial. If you don’t sign up for Part A when you’re first eligible, you could face late penalties. For most people, eligibility begins at age 65, but some qualify earlier due to disability or certain medical conditions.

Consider Additional Coverage

Since Medicare Part A has gaps, many people look into Medicare Supplement (Medigap) policies or Medicare Advantage plans for additional coverage. These can help cover some of the out-of-pocket costs Medicare leaves behind.

Plan for Prescription Drug Costs

Because Medicare Part A doesn’t cover outpatient prescription drugs, you may need Medicare Part D or another form of drug coverage to help with medication costs.

Be Prepared for Long-Term Care Needs

Medicare does not cover long-term care beyond skilled nursing facility stays. If you anticipate needing long-term care in the future, look into options like long-term care insurance or Medicaid eligibility for assistance.

What Happens If You Don’t Plan Ahead?

If you rely solely on Medicare Part A without considering its gaps, you could face:

• Large hospital bills if your stay extends beyond covered limits

• High out-of-pocket costs for skilled nursing care

• No coverage for essential services like vision, dental, and hearing care

• Significant expenses for long-term care if you need extended nursing home care

Making the Right Choices for Your Healthcare Future

Medicare Part A is a crucial part of your healthcare coverage, but it doesn’t cover everything. Understanding the costs and gaps ahead of time can help you make informed decisions about supplemental coverage, prescription drug plans, and long-term care planning.

If you want personalized advice, get in touch with a professional listed on this website. They can help you review your options and ensure you have the right coverage to protect yourself from unexpected medical expenses.