Key Takeaways

• Medicare Part A does not provide full financial protection for extended hospital stays. You are responsible for deductibles, coinsurance, and time-limited coverage.

• Beyond 90 days in a hospital, you must use lifetime reserve days or pay the full cost. Once these are exhausted, the financial burden falls entirely on you.

Hospital Coverage Basics Under Medicare Part A

When you’re admitted to a hospital, Medicare Part A helps cover essential inpatient services, including semi-private rooms, nursing care, meals, and certain medications. In 2025, many assume that Part A is a safety net that covers most or all of the costs—but that’s only true to a point.

You don’t pay monthly premiums for Part A if you’ve worked and paid Medicare taxes for at least 40 quarters. However, having premium-free Part A does not mean you have cost-free care.

What Part A Covers

• Inpatient hospital care

• Skilled nursing facility care (short-term, following a hospital stay)

• Hospice care

• Limited home health care

Even though these services are covered, how long you stay and how much care you need dramatically affects what you pay out of pocket.

The Financial Limits of Part A Coverage

Hospital Deductibles and Coinsurance (2025)

• Inpatient hospital deductible: $1,676 per benefit period

• Days 1–60: You pay nothing after the deductible

• Days 61–90: You pay $419 per day

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

• After day 150: You pay all costs

As you can see, Medicare’s protection weakens the longer you stay in the hospital. The system assumes most hospital stays are brief—and penalizes you financially if they’re not.

Lifetime Reserve Days: A One-Time Safety Net

Medicare gives you 60 lifetime reserve days to use beyond day 90 of a hospital stay. These are not renewable. Once you use them, they’re gone forever.

So, if you’re hospitalized for more than 90 days in 2025 and use 10 reserve days, you’ll only have 50 left for any future hospital stays. After you exhaust your 60 days, Medicare stops paying entirely beyond day 90 in any future benefit period.

Why This Matters

• Chronic illness or severe injury can lead to repeated, extended hospitalizations.

• The financial exposure increases with each long stay.

• Once reserve days are gone, you’re responsible for the full cost—potentially thousands per day.

Benefit Periods: The Reset Isn’t Always Helpful

A benefit period begins when you enter the hospital and ends when you haven’t received inpatient care for 60 consecutive days. This can work in your favor—if you’re discharged and stay out of a hospital for two months, your benefit period resets.

However, it can also work against you. If you’re hospitalized again after 60 days, you start a new benefit period, which means you owe the full $1,676 deductible again, even if your last stay was just a few weeks ago.

Skilled Nursing Facility (SNF) Limits

Many people require a skilled nursing facility after a hospital stay, often for recovery or rehab. Medicare Part A covers this—but only under specific conditions:

• You must have had a qualifying 3-day inpatient hospital stay

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

• Care must be medically necessary and provided by licensed professionals

Coverage Timeline and Costs (2025)

• Days 1–20: $0 (covered in full)

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

• After day 100: You pay all costs

Again, Medicare coverage runs out quickly. If your recovery takes longer than expected—or if you need SNF care more than once in a short period—the expenses can escalate rapidly.

What Medicare Doesn’t Cover During a Long Stay

Even with Part A, there are several categories of services you’ll need to pay for during a long hospital stay:

• Personal items (toiletries, television access, phone calls)

• Private duty nursing (unless specifically ordered and covered)

• Non-medical services (e.g., custodial care or long-term assistance)

These expenses, though smaller individually, can add up during an extended hospital or SNF stay.

Hospice: Different Rules, But Limits Still Apply

Hospice care under Part A is available if you’re terminally ill and have elected to forgo curative treatment. While this type of care has broader coverage, it’s not unlimited:

• You must recertify eligibility every 90 days, then every 60 days

• You may have out-of-pocket costs for respite care and certain medications

Part A won’t cover care received outside of your hospice plan or unrelated to your terminal illness.

The Role of Medigap or Other Coverage

Many enrollees purchase supplemental coverage to fill the gaps Part A leaves behind. These may help with:

• Deductibles

• Coinsurance for hospital and SNF stays

• Costs after lifetime reserve days are exhausted

However, you must qualify for such coverage and enroll during eligible periods. Delays or health changes can make it harder or more expensive to get these plans.

If You Only Rely on Part A in 2025

Choosing to go without supplemental coverage and relying solely on Part A exposes you to considerable risk:

• A single hospital stay beyond 90 days can wipe out your reserve days

• A second long stay will leave you paying 100% of costs after day 90

• SNF stays beyond 100 days receive no Medicare help at all

With healthcare inflation, these uncovered costs can be catastrophic.

Planning Strategies That Can Help

To protect yourself from unexpected bills:

• Track your lifetime reserve days and benefit periods

• Understand the reset rules around benefit periods

• Ask your providers to clarify when and how your care is billed

• Consider speaking with a licensed agent listed on this website about additional options to reduce out-of-pocket costs

Staying informed puts you in a better position to make care and coverage decisions under pressure.

Protecting Yourself From Gaps in Coverage

Understanding where Medicare Part A stops is just as important as knowing where it begins. Many people are surprised to learn that their benefits don’t stretch far enough during prolonged or repeated hospital stays. The timing of admissions, discharges, and care transitions all impact your costs. And once your lifetime reserve days are used, you face the full financial burden for extended stays.

Before you need care, get a clear picture of how Part A would respond—and whether additional coverage could keep you protected.

If you need help sorting through your options, reach out to a licensed agent listed on this website for guidance that fits your situation.