What Medicare Part A Pays For

Medicare Part A covers inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services. It does not cover outpatient doctor visits, prescription drugs, or long-term custodial care in a nursing home. Part A is hospital insurance — it pays when you are admitted to a hospital bed or move to a facility for medical recovery after a hospital stay.

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working. However, you will pay a deductible when you use it, and costs vary depending on how long you stay in the hospital or facility.

Key Takeaways

  • Medicare Part A covers a hospital stay, skilled nursing facility care after hospitalization, hospice services, and limited home health visits ordered by a doctor.
  • You pay a single deductible per benefit period for hospital care, no matter how many days you stay, but you pay daily coinsurance costs after day 60 in a hospital.
  • Skilled nursing facility care is covered for up to 100 days per benefit period, but only if you were hospitalized for at least three days first.
  • Part A does not cover custodial care (help with bathing, dressing, eating) in a nursing home, assisted living, or ongoing care at home without a medical reason.
  • You should review your Part A coverage before a planned hospital stay or surgery so you understand what costs you will owe.

Hospital Inpatient Care

Part A covers the full cost of a hospital room, meals, nursing care, and standard medical equipment while you are admitted as an inpatient. You must be formally admitted — staying in an observation bed does not count as inpatient admission, even if you are in the hospital overnight. Ask the hospital staff whether you are being admitted as an inpatient or kept for observation, because the distinction changes what Part A will pay.

For each benefit period, you pay a single deductible (the amount is set by Medicare each year and changes annually). After you meet the deductible, Part A covers all approved hospital costs for days 1 through 60. From day 61 to day 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you can use lifetime reserve days — Medicare allows 60 of these over your entire lifetime, and you pay a higher daily coinsurance for each one you use.

A benefit period starts the day you are admitted to the hospital and ends 60 days after you leave. If you are readmitted after that 60-day window closes, a new benefit period begins and you owe a new deductible.

Skilled Nursing Facility Care

Part A covers care in a skilled nursing facility (SNF) — a facility that provides medical care and rehabilitation, not just custodial help. You must meet three conditions: you must have been hospitalized for at least three consecutive days (not counting the day you leave), you must be admitted to the SNF within 30 days of leaving the hospital, and a doctor must order the care as medically necessary.

Part A covers up to 100 days per benefit period. For days 1 through 20, Part A pays the full cost. From day 21 to day 100, you pay a daily coinsurance amount. After day 100, you pay all costs yourself. Many people think Medicare covers long-term nursing home care, but it does not — Part A covers only the skilled care portion of a stay, and only for a limited time.

The difference between skilled care and custodial care matters. Skilled care means a nurse or therapist is actively treating you — for example, physical therapy after a hip replacement, wound care after surgery, or medication management for a new condition. Custodial care means help with daily activities like bathing, dressing, or eating. Part A does not pay for custodial care, even in a nursing home.

Hospice Care

Part A covers hospice services when a doctor certifies that you have a terminal illness and have six months or less to live. Hospice focuses on comfort and quality of life rather than curing the illness. Part A covers doctor visits, nursing care, pain medication, counseling, and some medical equipment and supplies.

You pay nothing for hospice services covered by Part A, except for a small coinsurance amount for prescription drugs and inpatient respite care (a short hospital stay to give your family a break). You do not need to be in a hospice facility — most hospice care happens at home, and Part A will pay for it.

If you choose hospice, you are saying you want to focus on comfort rather than treatment. You can change your mind and leave hospice at any time, and your other Medicare coverage will resume.

Home Health Services

Part A covers home health services when a doctor orders them and you are homebound or have difficulty leaving home. Services must be skilled care — nursing visits, physical therapy, occupational therapy, or speech therapy. Part A does not cover ongoing personal care like bathing or meal preparation unless it is part of a skilled service.

You pay nothing for home health services covered by Part A. However, if you need equipment like a wheelchair or oxygen, you may owe 20 percent coinsurance, and that cost is covered under Part B, not Part A.

What Part A Does Not Cover

Part A does not cover outpatient care — doctor office visits, emergency room visits (unless you are admitted to the hospital), lab tests, or imaging done outside a hospital. It does not cover prescription drugs, dental care, vision care, hearing aids, or routine physical exams. It does not cover custodial care in any setting, whether at home or in a facility.

Part A also does not cover care in a hospital or facility outside the United States, except in limited cases near the U.S. border. If you travel internationally and need medical care, you will pay out of pocket.

Understanding Your Costs and Deductibles

Your Part A costs depend on how you use it. If you have a short hospital stay, you pay only the annual deductible. If you stay longer than 60 days, daily coinsurance kicks in. If you move to a skilled nursing facility, you pay nothing for the first 20 days, then daily coinsurance from day 21 to day 100.

The deductible and coinsurance amounts change each year. You can find the current amounts on Medicare.gov or call 1-800-MEDICARE. Before a planned hospital stay or surgery, ask your hospital or doctor's office what your Part A costs will be based on the expected length of stay.

If you have a Medigap policy (supplemental insurance) or a Medicare Advantage plan, your out-of-pocket costs may be lower. Medigap plans often cover the Part A deductible and coinsurance. Medicare Advantage plans have their own cost structure and may have different deductibles and coinsurance amounts.

Questions to Ask Your Doctor or Hospital

Before a planned hospital stay, ask whether you will be admitted as an inpatient or kept for observation. Ask how many days the hospital expects you to stay. If you might need skilled nursing care afterward, ask whether the hospital can arrange it and whether it will be covered by Part A.

If you are unsure whether a service is covered, ask your doctor or the facility billing department. You can also call 1-800-MEDICARE to ask about specific services or situations. Having this information before you are admitted helps you plan for costs and understand what to expect.

Frequently Asked Questions

Does Medicare Part A cover observation stays in the hospital?

No. Observation is outpatient status, so Part A does not cover it. You pay coinsurance for observation services, which are covered under Part B. This matters because if you are in observation and then need a skilled nursing facility, you may not meet the three-day hospital admission requirement for Part A to cover the SNF stay.

What happens if I stay in a skilled nursing facility longer than 100 days?

Part A stops paying after day 100 in a benefit period. You pay all costs yourself after that point. Some people have long-term care insurance that covers costs after Part A ends, or they use Medicaid if they meet income and asset limits. Talk to a social worker at the facility about your options.

Can Part A cover care at home instead of a nursing facility?

Yes, if a doctor orders home health services and you are homebound or have difficulty leaving home. Home health must be skilled care — nursing, therapy, or medical treatment. Part A does not cover ongoing help with bathing, dressing, or meals unless those services are part of a skilled nursing visit.

Do I have to pay the Part A deductible every time I go to the hospital?

No. You pay one deductible per benefit period, which lasts from the day you are admitted until 60 days after you leave. If you are readmitted after that 60-day window, a new benefit period starts and you owe a new deductible.

What should I do if I receive a bill for something I thought Part A covered?

Contact the hospital or facility billing department and ask why the charge was not covered. If you disagree, you can file an appeal with Medicare. Call 1-800-MEDICARE to report the issue or to understand your appeal rights.