Key Takeaways

• Medicare Part A is often misunderstood as covering all hospital-related costs, but it has significant gaps that can lead to high out-of-pocket expenses if you’re not prepared.

• Understanding the limits of what Part A covers in 2025 helps you plan better and avoid unexpected costs during hospital stays or related services.

What Medicare Part A Actually Covers in 2025

Medicare Part A is referred to as “hospital insurance,” and at its core, it does provide essential inpatient coverage. In 2025, this includes:

• Inpatient hospital stays: Up to 90 days per benefit period, with an additional 60 lifetime reserve days.

• Skilled nursing facility care: Up to 100 days after a qualifying hospital stay of at least three consecutive days.

• Home health care: Intermittent skilled nursing care and therapy services when medically necessary.

• Hospice care: For terminally ill patients with a life expectancy of six months or less, if comfort care is chosen over curative treatment.

But while those sound comprehensive, the real story is in what Medicare Part A doesn’t cover or only partially covers.

The 2025 Costs You Can’t Ignore

Even when Medicare Part A covers a service, you are not off the hook financially. Here are the current 2025 costs associated with Part A:

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

• Hospital coinsurance:

  • Days 1–60: $0 (after the deductible is paid)

  • Days 61–90: $419 per day

  • Lifetime reserve days (91–150): $838 per day

• Skilled nursing facility coinsurance:

  • Days 1–20: $0

  • Days 21–100: $209.50 per day

• Hospice care: Typically free, but you may pay small copayments for prescriptions or inpatient respite care.

These charges add up quickly, especially if your hospital stay is extended or you require skilled nursing care.

What Part A Leaves Out Entirely

Medicare Part A doesn’t cover everything you might assume falls under hospital-related care. Here’s what’s entirely excluded:

• Physician services during your hospital stay – These fall under Medicare Part B.

• Private-duty nursing – If you want one-on-one care beyond what’s considered medically necessary, you pay the full cost.

• A private room – Unless medically necessary, you’re responsible for any additional charges.

• Personal items – Such as TV rental, phone calls, or toiletries during your stay.

• Custodial care – Non-medical assistance with daily activities, even in a facility.

Understanding these exclusions helps you avoid the assumption that everything in a hospital is automatically covered.

How Medicare Defines a Benefit Period

Medicare’s concept of a “benefit period” is central to how costs apply. A benefit period starts the day you are admitted as an inpatient and ends 60 days after you’ve been discharged. If you’re re-admitted after that, a new benefit period—and a new deductible—begins.

This means you could pay the $1,676 deductible more than once in a single year if you have multiple hospitalizations separated by more than 60 days.

Coverage Limits for Skilled Nursing Facilities

A common misconception is that Medicare Part A provides long-term care coverage. It doesn’t.

You only qualify for skilled nursing facility coverage under Part A if:

• You had a qualifying hospital stay of at least three consecutive days.

• You need skilled care related to that hospital stay.

• Your doctor certifies the need.

Even then, you get just 100 days per benefit period. After Day 100, you’re fully responsible for all costs.

How Part A Coordinates With Other Parts of Medicare

Since Medicare Part A does not cover everything, most beneficiaries combine it with:

• Medicare Part B: For doctor services, outpatient care, and preventive care.

• Medicare Part D: For prescription drug coverage.

In addition, many individuals opt for supplemental insurance to cover deductibles, coinsurance, and other out-of-pocket expenses. While those policies can be helpful, they’re not part of Original Medicare.

The Role of Hospice and End-of-Life Care

Hospice is one area where Medicare Part A offers broader coverage. If your doctor certifies that you are terminally ill with six months or less to live, you can receive hospice care, typically at home.

Hospice coverage includes:

• Nursing and doctor services

• Medical equipment and supplies

• Prescription drugs for symptom control or pain relief

• Hospice aide and homemaker services

• Grief and loss counseling for family

You generally don’t pay for hospice care, but you might owe a copayment of up to $5 per prescription and 5% of the Medicare-approved amount for inpatient respite care.

Pitfalls When Relying Solely on Part A

Relying only on Medicare Part A could leave you exposed to significant gaps:

• You face high out-of-pocket costs if hospitalized multiple times.

• You may not qualify for skilled nursing facility coverage.

• You get no help with outpatient services, doctor visits, or prescription drugs.

• You may exhaust your 60 lifetime reserve days, after which you pay the full cost of hospital care.

The gaps are real, and in many cases, very expensive.

When You Become Eligible and How to Enroll

If you’re already receiving Social Security or Railroad Retirement Board benefits, you’re automatically enrolled in Medicare Part A when you turn 65.

If not, you need to sign up during one of these windows:

• Initial Enrollment Period (IEP): A 7-month window starting 3 months before your 65th birthday.

• General Enrollment Period (GEP): January 1 to March 31 each year if you missed your IEP.

• Special Enrollment Period (SEP): If you delayed enrollment due to employer coverage, you can enroll without penalty.

Most people don’t pay a premium for Part A if they’ve worked and paid Medicare taxes for at least 40 quarters (10 years). If you haven’t, the monthly premium in 2025 is up to $518.

How to Prepare for Costs Not Covered by Part A

You can’t rely on Part A alone and expect to be fully protected from medical expenses. Here’s how you can prepare:

• Consider enrolling in Medicare Part B and Part D to cover medical and drug costs.

• Look into supplemental coverage to help with deductibles and coinsurance.

• Budget for non-covered services like custodial care, private nursing, and long-term care.

• Review your coverage annually to ensure it still meets your health and financial needs.

Planning ahead ensures you won’t be caught off guard by the many costs that fall outside the scope of Medicare Part A.

Why Comprehensive Planning Matters in 2025

With healthcare costs continuing to rise, understanding the limits of Medicare Part A is more important than ever. The gaps in hospital insurance can lead to financial strain during critical times—unless you’ve taken steps to fill them.

You deserve confidence, not confusion, when it comes to your coverage.

Make sure you’re looking at the full picture, not just the label “hospital insurance.” Talk to a licensed agent listed on this website for a personalized review of your options and to ensure your Medicare choices actually support your health and your wallet.