Key Takeaways

• Medicare Part A does not cover all hospital-related costs, and you may be responsible for significant out-of-pocket expenses—even with coverage.

• Understanding coverage limits, benefit periods, and cost-sharing rules in 2025 can help you avoid surprise hospital bills and plan more confidently for care.

Medicare Part A: What It Actually Covers

Medicare Part A, also known as hospital insurance, is designed to help cover inpatient care. In 2025, it includes the following major services:

• Inpatient hospital care: Semi-private rooms, meals, general nursing, and drugs as part of inpatient treatment

• Skilled nursing facility (SNF) care: Only after a qualifying 3-day inpatient hospital stay

• Home health care: Limited, and only if deemed medically necessary

• Hospice care: For terminally ill patients who elect to forego curative treatments

However, just because these services are covered doesn’t mean all costs are paid. Medicare Part A includes a range of cost-sharing elements that you’ll need to pay attention to.

The 2025 Part A Deductible and Benefit Periods

In 2025, the Medicare Part A deductible per benefit period is $1,676. A benefit period begins the day you’re admitted to a hospital and ends after you haven’t received inpatient or skilled nursing care for 60 days in a row.

If you’re readmitted after 60 days, a new benefit period begins—and with it, a new deductible. This can be a financial shock for those experiencing multiple hospital stays in a year.

Daily Coinsurance Charges

If you remain hospitalized beyond 60 days in a single benefit period, additional costs kick in:

• Days 61–90: You pay $419 per day

• Days 91–150: You pay $838 per day (using your 60 lifetime reserve days)

• After 150 days: You pay 100% of all costs

This structure means that long hospital stays or multiple hospitalizations within a year can add up quickly, even if you have Medicare Part A.

Skilled Nursing Facility Coverage Has Conditions

One of the biggest misconceptions about Medicare Part A is that it automatically covers nursing home stays. In reality, coverage for skilled nursing facilities is conditional and time-limited:

• You must have a 3-day inpatient hospital stay (not including observation status)

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

• Care must be medically necessary and ordered by a doctor

If these conditions are met, here’s what Medicare Part A covers in 2025:

• Days 1–20: Fully covered

• Days 21–100: You pay $209.50 per day

• After 100 days: You pay all costs

Many people are surprised to learn that Medicare doesn’t cover custodial care—assistance with activities of daily living—unless it is part of qualified skilled care.

What Medicare Part A Doesn’t Cover

To avoid surprise bills, it’s important to know what Medicare Part A doesn’t cover. Here are common gaps:

• Outpatient services: These fall under Medicare Part B, not Part A

• Doctor’s services while in the hospital: Part B covers these separately

• Private rooms: Unless medically necessary

• Personal items: Toiletries, phone use, television, etc.

• Long-term care: Such as most nursing home and custodial care

If your hospital stay includes outpatient observation or services, those costs aren’t covered under Part A and could fall under Part B with separate cost-sharing rules.

Observation Status Can Be Costly

Hospitals can classify you as an outpatient under observation status even if you stay overnight. This matters because:

• Observation care is billed under Part B, not Part A

• You don’t qualify for SNF coverage unless you had a 3-day inpatient stay under Part A

• You may owe 20% of outpatient costs under Part B

Always ask your care team whether you’re considered an inpatient or under observation. That single distinction can make a significant financial difference.

Lifetime Reserve Days: Not Unlimited

Part A gives you 60 lifetime reserve days, used when your hospital stay exceeds 90 days in a single benefit period. However, these can only be used once in your lifetime. After they’re gone:

• You’re responsible for all hospital costs beyond day 90 in future benefit periods

This provision is often misunderstood. It’s crucial to remember that these reserve days don’t reset each year. Once used, they’re gone for good.

Other Potential Out-of-Pocket Costs

Even when Medicare Part A covers your hospital stay, you may still have other expenses:

• Blood transfusions: If the hospital has to buy the blood, you pay for the first 3 units

• Ambulance services: Only covered if medically necessary and transport is to the nearest appropriate facility

• Hospital readmissions: Each new benefit period can mean a new deductible

These additional costs may catch you off guard, especially if you’re assuming that Part A covers everything once admitted.

You May Still Need Part B

It’s a common misconception that Medicare Part A alone is sufficient. But in 2025, you’ll likely need Part B to fully address your medical needs during a hospital stay, including:

• Physician visits

• Diagnostic tests and imaging

• Emergency room services (if not leading to inpatient admission)

Without Part B, you could be responsible for all these services out-of-pocket—even if you’re hospitalized.

Planning Ahead to Avoid Surprise Bills

Here are a few smart steps you can take to reduce your chances of getting hit with unexpected hospital expenses:

• Verify your inpatient status: Always confirm whether you’re being admitted as an inpatient or under observation

• Understand benefit periods: Track hospitalizations to anticipate deductibles and reserve days

• Review discharge plans: Ensure you qualify for any skilled nursing care if it’s needed

• Consider coverage gaps: Evaluate whether additional coverage may be worth considering based on your health needs

Being proactive can help you make informed decisions and avoid confusion when the bills arrive.

Medicare Part A in 2025: Still Valuable, But Not All-Inclusive

Medicare Part A remains a foundational part of your hospital insurance in 2025, but it is far from all-encompassing. From benefit periods to coinsurance costs, and from inpatient versus observation status to SNF qualifications, many aspects of the program can result in unexpected expenses.

If you’re planning ahead or recovering from a hospital visit, don’t assume everything is covered. There are real limitations—some of which could cost thousands if you’re not prepared.

To make sure you understand how Medicare fits your situation, speak with a licensed agent listed on this website who can walk you through your options.