Key Takeaways

• Medicare Part A only covers certain hospital-related expenses and comes with significant cost-sharing responsibilities, especially after 60 days of inpatient care.

• To protect yourself from high out-of-pocket expenses, it’s essential to consider backup coverage options that fill the gaps Part A leaves behind.

Understanding What Medicare Part A Covers in 2025

Medicare Part A is often called “hospital insurance,” and for many people, it feels like a free benefit once they reach age 65. If you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), you qualify for premium-free Part A. However, the term “free” can be misleading.

While you may not pay a monthly premium for Part A, the services it covers are limited, and the cost-sharing requirements can be substantial. In 2025, Part A covers:

• Inpatient hospital care

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

• Hospice care

• Some home health services

But coverage doesn’t mean full payment. There are deductibles, coinsurance, and benefit period limits that can expose you to high costs.

The Reality of Inpatient Costs Beyond the Deductible

As of 2025, when you’re admitted to a hospital, Medicare Part A requires you to pay a $1,676 deductible for each benefit period—not annually. A benefit period begins the day you’re admitted as an inpatient and ends after you’ve been out of the hospital or skilled nursing facility for 60 consecutive days.

If you stay in the hospital beyond 60 days within the same benefit period, you’ll start incurring daily coinsurance:

• Days 1–60: $0 coinsurance (after you’ve paid the deductible)

• Days 61–90: $419 per day

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

• After 150 days: You pay all costs

Clearly, if you experience a long-term hospitalization or need frequent inpatient care within the year, these out-of-pocket costs can become unmanageable.

Skilled Nursing Facility Coverage Isn’t Unlimited Either

Another area where Part A shows its limits is skilled nursing facility (SNF) care. Medicare only covers SNF care if you had a hospital stay of at least three consecutive days prior to transfer, and the facility is Medicare-certified.

Here’s what you’re responsible for in 2025:

• Days 1–20: $0 per day

• Days 21–100: $209.50 per day

• After 100 days: You pay all costs

SNF coverage resets only if you’ve been out of inpatient or SNF care for at least 60 days. This means that needing more than 100 days of care in a given period could leave you exposed to full costs.

Hospice Care Is Covered—But Limited to Specific Scenarios

Medicare Part A covers hospice care, but only for individuals certified by a physician to be terminally ill with a life expectancy of six months or less. Even then, hospice does not include room and board, 24/7 care at home, or treatments intended to cure the illness.

If you require services outside of the hospice parameters, Medicare may not pay at all. And for medications, you may pay a small coinsurance for outpatient drugs related to your terminal condition.

Home Health Services Under Part A Are Conditional

Many assume home health care is fully covered under Part A, but that’s only partially true. Part A covers it only if it follows a hospital or SNF stay. Otherwise, it falls under Part B.

Even when covered under Part A, eligibility hinges on:

• Being homebound

• Needing skilled nursing or therapy services

• Having a doctor certify the care as medically necessary

And again, services like long-term personal care or 24-hour home health aide support are not covered.

What Medicare Part A Doesn’t Cover at All

To understand why backup coverage is so critical, you need to know what Medicare Part A entirely excludes. It doesn’t cover:

• Outpatient medical services

• Routine doctor visits

• Prescription drugs (outside of hospice care)

• Dental, vision, and hearing care

• Custodial care (e.g., help with bathing, dressing)

These are among the most common services older adults require regularly, and they must be covered another way—either by paying out of pocket or having additional coverage.

Why Part A Alone Isn’t Enough in 2025

Despite having premium-free access, relying solely on Medicare Part A leaves you with large financial gaps in the event of:

• Extended hospital stays

• Rehabilitation in skilled nursing facilities

• Unexpected home health needs

• Terminal illness support

Even just two hospital stays that fall into separate benefit periods could mean paying the $1,676 deductible twice. If those stays extend beyond 60 days, your coinsurance costs multiply quickly.

For most people living on fixed retirement income, these costs aren’t sustainable without some form of supplemental protection.

Backup Coverage Options That Fill the Gaps

You have several options to protect yourself from the limitations of Medicare Part A:

1. Enroll in Medicare Part B

Part B covers most outpatient services, including:

• Doctor visits

• Lab tests

• Preventive services

• Durable medical equipment

• Outpatient surgeries

It complements Part A to provide broader protection. In 2025, the standard Part B premium is $185, with an annual deductible of $257.

2. Add Prescription Drug Coverage (Part D)

Prescription drugs are not covered under Part A, and they are essential to most treatment plans. Enrolling in a Part D plan ensures coverage for most medications.

3. Consider Supplemental Coverage

Also known as Medigap, supplemental plans help pay the costs Part A and B don’t cover, such as deductibles and coinsurance. You must be enrolled in both Part A and B to be eligible.

4. Look at Retiree or Employer Coverage

Some retirees have access to health plans through a former employer or union. These plans can offer secondary coverage that coordinates with Medicare.

5. Evaluate Medicaid If You Qualify

For those with limited income and resources, Medicaid can provide additional help covering Medicare costs, including long-term care services that Medicare excludes.

Timing Your Backup Coverage Enrollment Is Crucial

Backup coverage only works if you enroll at the right time. You have several key windows to act:

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday

• Special Enrollment Period (SEP): If you delayed Part B due to employer coverage

• Annual Enrollment Period (AEP): October 15 to December 7 each year

• General Enrollment Period (GEP): January 1 to March 31, with coverage starting July 1

Missing these windows can lead to late enrollment penalties or coverage delays, especially with Part B and Part D.

Out-of-Pocket Maximums Still Matter

One key issue with Original Medicare, including Part A, is the absence of an annual out-of-pocket maximum. That means there is no hard cap on your spending if you require extensive care in a year.

Adding supplemental insurance or other backup coverage often introduces a maximum limit, protecting you from catastrophic costs.

Long-Term Care Is a Major Blind Spot

One of the most overlooked areas not covered by Medicare Part A is long-term custodial care. This includes assistance with daily living activities in a nursing home or at home.

Most individuals will need some form of long-term care as they age. Without other insurance or savings, this cost can quickly drain your resources. Medicare does not fill this gap.

Backup coverage or long-term care insurance, if accessible, can help preserve your savings and reduce the financial strain on your family.

What This Means for You in 2025

If you’re relying solely on Medicare Part A for your healthcare needs, you’re at risk of facing significant gaps in coverage and major out-of-pocket expenses. Part A does serve as a foundational layer, but not a full solution.

To protect your health and finances, it’s essential to:

• Pair Part A with Part B and/or Part D

• Add supplemental insurance where possible

• Understand what services you’re likely to need

• Take action during the correct enrollment periods

Don’t Let Medicare Gaps Catch You Off Guard

Medicare Part A may seem like a sufficient base of coverage, but the financial risks it leaves you with can be severe. From uncovered services to benefit period limitations, Part A works best when it’s not your only source of coverage.

Take time to review your full healthcare needs and compare your options. To avoid unnecessary surprises, speak with a licensed agent listed on this website who can help you explore plans tailored to your situation.