Key Takeaways

• Medicare Part A does not cover everything—and the uncovered portions can cost you thousands if you’re not prepared.

• Hospital stays beyond 60 days, skilled nursing care limits, and late enrollment penalties are common areas where costs sneak up on beneficiaries.

What Medicare Part A Covers (And What It Doesn’t)

Medicare Part A is often referred to as hospital insurance. While that’s true, the name itself can be misleading. You might assume it covers all your inpatient needs, but the reality is more nuanced.

Covered Services

Part A covers:

• Inpatient hospital care (when formally admitted)

• Skilled nursing facility care (under specific conditions)

• Home health care (limited and specific)

• Hospice care (for terminally ill patients)

However, even these services come with conditions and cost-sharing responsibilities.

Services Not Covered

You won’t find coverage for the following under Part A:

• Long-term custodial care (help with daily activities)

• Private-duty nursing

• Personal care aides

• Non-medical home care

• Most outpatient services

Understanding the limits of Part A is essential for making informed decisions about supplemental coverage.

The Cost of “Free” Hospital Coverage

You might qualify for premium-free Medicare Part A if you or your spouse paid Medicare taxes for at least 40 quarters (10 years). But premium-free doesn’t mean cost-free.

2025 Cost Breakdown

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

• Coinsurance for hospital stays:

  • Days 1–60: $0

  • Days 61–90: $419 per day

  • Days 91 and beyond: $838 per lifetime reserve day (up to 60 days over your lifetime)

  • After lifetime reserve days: You pay all costs

• Skilled nursing facility care coinsurance:

  • Days 1–20: $0

  • Days 21–100: $209.50 per day

  • After day 100: You pay all costs

These costs can quickly escalate if your hospital stay is extended or if you require prolonged care.

The Benefit Period Trap

Medicare Part A operates on a “benefit period” model rather than a calendar year. A benefit period begins the day you’re admitted as an inpatient and ends after you haven’t received any inpatient hospital care (or skilled nursing facility care) for 60 days in a row.

This structure resets the deductible and coinsurance. So, if you’re hospitalized again after the benefit period ends, you’re responsible for a new $1,676 deductible.

If you experience multiple hospital stays in a year, you may find yourself paying that deductible more than once.

Late Enrollment Penalties Can Add Up

If you miss your Initial Enrollment Period (IEP), which is the 7-month window around your 65th birthday (3 months before, the month of, and 3 months after), you may face a penalty.

The Part A Penalty

If you must buy Part A and don’t enroll when first eligible, your monthly premium may go up by 10%. This penalty applies for twice the number of years you didn’t sign up.

Even though most people don’t pay premiums, those who do (typically with fewer than 30 quarters of work history) can face hundreds in penalties.

Skilled Nursing Facility: Coverage Comes with Strings Attached

Skilled nursing facility (SNF) care under Part A is often misunderstood. Many assume it covers any nursing home stay. It doesn’t.

To qualify for coverage:

• You must have a prior qualifying hospital stay of at least 3 consecutive inpatient days (not including the discharge day).

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

• Care must be medically necessary and provided by a Medicare-certified facility.

If any of these conditions aren’t met, you’re on the hook for the full cost—which can be thousands per month.

Observation Status vs. Inpatient Admission

You may think being in the hospital automatically triggers Part A coverage, but that depends on whether you’re admitted as an inpatient or kept under observation status.

Observation care is considered outpatient and billed under Part B, not Part A. This distinction matters because:

• Observation days don’t count toward the 3-day inpatient requirement for skilled nursing care.

• Part A won’t cover your SNF stay if your hospital time was all under observation.

• You could owe more in copays under Part B while still expecting Part A coverage.

Always confirm your hospital status to avoid costly surprises.

Hospice Coverage: Only in Specific Circumstances

Medicare Part A covers hospice care for beneficiaries diagnosed with a terminal illness and a life expectancy of 6 months or less, certified by a doctor.

You must sign a statement choosing hospice care instead of curative treatment. Coverage includes:

• Pain relief and symptom management

• Hospice-related drugs

• Respite care for caregivers (up to 5 days)

• Medical equipment and supplies

It does not cover room and board if you’re in a facility unless it’s for respite or short-term symptom control.

Home Health Care Isn’t Always an Option

While Medicare Part A includes some home health services, these are limited and require strict eligibility:

• You must be homebound.

• A doctor must certify you need intermittent skilled nursing or therapy services.

• A Medicare-certified home health agency must provide the care.

Routine personal care, meals, and housekeeping are not covered. Many people assume Medicare helps with aging-in-place care, but in most cases, Part A won’t.

You May Need Additional Coverage to Fill the Gaps

Because Medicare Part A leaves significant gaps, most beneficiaries choose to add more protection through:

• Medicare Part B (medical insurance)

• Medicare Part D (prescription drug coverage)

• A Medigap (Medicare Supplement) policy

• Or a Medicare Advantage plan (Part C), which combines multiple benefits

Each option comes with trade-offs, timelines, and eligibility rules. But choosing to rely on Part A alone is rarely sufficient.

Planning Ahead Means Avoiding Financial Shock

Understanding how Medicare Part A works is essential to preventing unexpected bills. You should review your potential needs and ask questions like:

• What happens if I’m hospitalized multiple times in one year?

• Would I qualify for skilled nursing coverage?

• Am I at risk of missing enrollment deadlines?

• Do I need additional coverage to protect my retirement income?

Being proactive means fewer surprises when you’re already dealing with a health issue.

Don’t Let Assumptions Derail Your Medicare Strategy

Medicare Part A is a vital benefit, but it isn’t designed to stand alone. If you misunderstand or overlook its fine print, you could face thousands in unexpected costs for hospital stays, skilled nursing, or in-home care.

A smart strategy begins with education. Review your Medicare timeline, assess your care needs, and explore coverage options that fit your budget and health profile.

Get in touch with a licensed agent listed on this website to get answers specific to your situation and support in making Medicare decisions with confidence.