Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services

Part A is hospital insurance. It pays for care you receive as an inpatient — meaning you are admitted to a hospital or facility overnight — rather than care you get as an outpatient in a doctor's office or emergency room. Part A also covers skilled nursing facilities (nursing homes where you receive medical care, not just information with daily living), hospice care for terminal illness, and home health services ordered by a doctor.

Part A is automatic. If you are 65 or older and a U.S. citizen or permanent resident who has lived in the country for at least five years, you are enrolled in Part A when you turn 65, even if you do not sign up. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years while working. If you did not work long enough, you can still buy Part A, but the cost is higher.

Part A has deductibles and coinsurance — amounts you pay out of pocket. The deductible is the amount you pay before Medicare starts to pay. Coinsurance is a percentage or daily amount you pay after the deductible. These amounts change each year.

Key Takeaways

  • Part A pays for inpatient hospital care, skilled nursing facility stays after a hospital stay, hospice care, and home health services ordered by your doctor.
  • You do not pay a monthly premium for Part A if you worked and paid Medicare taxes for at least 10 years, but you do pay a deductible and daily coinsurance amounts.
  • Part A does not cover outpatient services like doctor visits, lab tests, or imaging done in a clinic or office setting.
  • You must be admitted as an inpatient (staying overnight) for Part A to cover the cost; observation status in a hospital does not count as inpatient admission.

What Part A covers in a hospital

Part A covers a semiprivate room (two or more beds), meals, nursing care, medications given to you in the hospital, and medical equipment and supplies used during your stay. It also covers lab tests, imaging (X-rays, CT scans, ultrasounds), and surgery performed in the hospital. If you need blood transfusions, Part A covers the blood itself after you pay for the first three pints.

Part A does not cover a private room unless it is medically necessary. It does not cover television, telephone, or personal care items. If you want a private room and it is not medically required, you pay the difference between the semiprivate rate and the private room rate yourself.

You pay a deductible for each benefit period. A benefit period starts the day you are admitted to the hospital and ends 60 days after you leave the hospital without being readmitted. If you are readmitted within 60 days, you are still in the same benefit period and do not pay another deductible. After the deductible, you pay coinsurance — a set daily amount — for days 1 through 60 of your stay. For days 61 through 90, you pay a higher daily coinsurance. Beyond 90 days, Part A does not cover your stay unless you use lifetime reserve days, which are extra days Medicare gives you once in your lifetime, and they also require coinsurance.

What Part A covers in a skilled nursing facility

Part A covers a skilled nursing facility (SNF) stay only if you were admitted to a hospital first and stayed at least three consecutive days (not counting the day you were discharged). You must be admitted to the SNF within 30 days of leaving the hospital, and a doctor must order the care. The SNF must be Medicare-certified.

Part A covers a semiprivate room, meals, skilled nursing care, physical therapy, occupational therapy, speech therapy, medications, medical equipment, and supplies. It does not cover custodial care — help with bathing, dressing, or using the toilet — unless it is part of skilled care you are receiving.

You pay nothing for days 1 through 20 of your SNF stay. For days 21 through 100, you pay a daily coinsurance amount. After 100 days in a benefit period, Part A does not cover SNF care. The benefit period is the same as your hospital benefit period — it resets 60 days after you leave the hospital without being readmitted.

What Part A covers for home health and hospice

Part A covers home health services — nursing care, physical therapy, occupational therapy, speech therapy, and medical equipment — if a doctor orders the care and you are homebound or have a medical reason you cannot leave home easily. You must receive the care from a Medicare-certified home health agency. You pay nothing for home health services covered by Part A, though you may pay 20 percent of the cost of medical equipment.

Part A covers hospice care for people with a terminal illness expected to live six months or less. A doctor must refer you, and you must choose a Medicare-certified hospice. Hospice covers pain management, symptom relief, nursing care, counseling, and medications related to your terminal condition. You pay nothing for hospice care itself, though you may pay small copayments for medications and respite care (temporary care that gives your family a break).

What Part A does not cover

Part A does not cover outpatient services — care you receive without being admitted overnight. This includes doctor visits in an office or clinic, emergency room visits that do not lead to admission, lab tests or imaging ordered by your doctor and done in an outpatient setting, and preventive care like screenings and vaccines. Those services are covered by Part B (medical insurance), not Part A.

Part A does not cover long-term custodial care in a nursing home — care that helps you with daily living but is not skilled medical care. It does not cover care in a facility that is not Medicare-certified. It does not cover care ordered by someone other than a doctor, such as a family member or social worker.

Part A also does not cover observation status in a hospital. Observation is a temporary status while a doctor decides whether to admit you. Even if you spend the night in a hospital bed on observation status, it does not count as an inpatient admission for Part A purposes. This distinction matters because it affects whether you can move to a skilled nursing facility and have Part A pay for it.

Understanding the costs: deductibles and coinsurance

Part A costs change each year. The hospital deductible applies once per benefit period. If you have multiple hospital stays within the same benefit period (within 60 days of each other), you pay the deductible only once. After you meet the deductible, you pay coinsurance — a daily amount — for each day you stay. The daily coinsurance is higher for longer stays.

For skilled nursing facilities, you pay nothing for the first 20 days, then a daily coinsurance amount for days 21 through 100. Home health and hospice have no coinsurance or copayments for the services themselves, though you may pay small amounts for certain medications or supplies.

If you have a Medigap policy (supplemental insurance) or a Medicare Advantage plan, that plan may cover some or all of your Part A costs. Check your plan documents or call the plan to understand what you owe.

When to ask your doctor or hospital about Part A coverage

Before you are admitted to a hospital, ask whether you will be admitted as an inpatient or placed on observation status. This affects what Part A covers and what you will owe. If you are on observation status and want to know whether it will change to inpatient admission, ask the hospital to tell you in writing.

Before you leave the hospital, ask whether Part A will cover a skilled nursing facility stay. If a doctor is recommending SNF care, confirm that you meet the three-day hospital stay requirement and that the facility is Medicare-certified. If you are unsure whether a service is covered, ask the hospital or facility before you receive it — they can tell you what Part A covers and what you may owe.

If you receive a bill for a service you thought Part A covered, contact Medicare at 1-800-MEDICARE (1-800-633-4227) to ask whether the service should have been covered. You have the right to appeal if Medicare or a provider tells you a service is not covered.

Frequently Asked Questions

Does Part A cover my doctor visits?

No. Part A covers inpatient care only — care you receive while admitted to a hospital or skilled nursing facility overnight. Doctor visits in an office or clinic are covered by Part B (medical insurance), not Part A. If you see a doctor in the hospital while you are an inpatient, that visit is covered as part of your hospital stay under Part A.

What is the difference between inpatient admission and observation status?

Inpatient admission means a doctor has decided you need to stay in the hospital overnight for medical care. Part A covers inpatient stays. Observation status means the hospital is monitoring you while a doctor decides whether to admit you. Even if you spend the night in a hospital bed on observation, it does not count as an inpatient admission, and Part A does not cover it the same way. Ask the hospital in writing whether you are being admitted as an inpatient or placed on observation.

Do I have to pay anything for home health care covered by Part A?

You pay nothing for home health nursing and therapy services covered by Part A. You may pay 20 percent of the cost of medical equipment like a wheelchair or oxygen. Home health must be ordered by a doctor and provided by a Medicare-certified agency.

What happens if I stay in the hospital longer than 90 days?

After 90 days in a benefit period, Part A does not cover your hospital stay unless you use lifetime reserve days. You have 60 lifetime reserve days that Medicare gives you once, and you pay a higher daily coinsurance for those days. After your lifetime reserve days are used, you pay all costs yourself. Talk to your hospital's billing department about your options if your stay is expected to be very long.

Can Part A cover a nursing home stay if I did not spend three days in the hospital first?

No. Part A covers skilled nursing facility care only if you were admitted to a hospital first and stayed at least three consecutive days. If you go directly to a nursing home from home or from an outpatient procedure, Part A does not cover it. You would pay for nursing home care yourself or through Medicaid if you meet income and asset limits.