What Medicare Part A Pays For

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health services. It does not cover outpatient doctor visits, prescription drugs, or routine preventive care — those fall under Part B and other parts of Medicare. Part A is hospital insurance, and it pays the facility directly when you are admitted as an inpatient, not for care you receive while living at home or visiting a doctor's office.

Most people do not pay a monthly premium for Part A if they or their spouse paid Medicare taxes for at least 10 years while working. If you did not work long enough to may have access to, you can still buy Part A, but the cost varies based on how many years of work history you have. Part A does have a deductible and coinsurance amounts you pay out of pocket, and those amounts change each year.

Key Takeaways

  • Part A covers the full cost of a hospital room, meals, and basic nursing care during an inpatient stay, after you meet the annual deductible.
  • Skilled nursing facility care is covered for up to 100 days per benefit period, but only if you were hospitalized first and meet other conditions.
  • Home health services are covered at no cost to you when ordered by a doctor and provided by a Medicare-approved agency, as long as you are homebound.
  • Part A does not cover outpatient services, doctor office visits, prescription drugs, or long-term custodial care in a nursing home.
  • You pay a deductible once per benefit period, then coinsurance amounts that depend on how long you stay in the hospital or facility.

Hospital Inpatient Care Covered by Part A

When you are admitted to a hospital as an inpatient, Part A covers a semi-private room (two beds), all meals, nursing care, and use of hospital equipment and supplies. It also covers anesthesia, operating room costs, lab tests, X-rays, and blood transfusions. If you need surgery or other procedures during your stay, Part A pays for those as well.

You pay a deductible for each benefit period — a benefit period starts when you enter the hospital and ends 60 days after you leave without being readmitted. In 2024, that deductible is $1,676, though the amount changes yearly. After you meet the deductible, Part A covers all inpatient hospital costs for days 1 through 60 of your stay. For days 61 through 90, you pay a daily coinsurance amount (in 2024, $419 per day). If you stay longer than 90 days, you can use your lifetime reserve days — you have 60 of these total, and they also require a daily coinsurance payment.

Skilled Nursing Facility Care

Part A covers care in a skilled nursing facility (SNF) — a facility that provides medical care and rehabilitation, not just room and board. The key requirement is that you must have been hospitalized for at least three consecutive days before moving to the SNF, and you must be admitted within 30 days of leaving the hospital. The SNF stay must be for the same condition you were hospitalized for, or a condition that developed during your hospital stay.

Part A covers up to 100 days per benefit period. For days 1 through 20, you pay nothing — Part A covers the full cost. For days 21 through 100, you pay a daily coinsurance amount (in 2024, $209.50 per day). After day 100, you pay all costs yourself. Many people assume a nursing home stay is covered by Part A, but Part A only covers skilled care — medical care and therapy provided by licensed nurses or therapists. If you need custodial care only (help with bathing, dressing, or meals), Part A does not pay, and you must cover those costs out of pocket or through Medicaid if you may have access to.

Home Health Services

Part A covers home health services when a doctor orders them, you are homebound (meaning it is difficult for you to leave home without help), and a Medicare-approved home health agency provides the care. Services include skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology. You pay nothing for home health services covered by Part A — no deductible, no coinsurance, no copay.

Home health is different from home care or personal care services. Part A covers skilled nursing and therapy only, not help with housekeeping, meal preparation, or personal care unless it is tied to a skilled service. For example, a nurse can help you bathe if you cannot do so safely after surgery, but Part A does not pay for a home aide to help you bathe for general reasons. The agency must be Medicare-approved, so ask your doctor or hospital discharge planner to refer you to one.

Hospice Care

Part A covers hospice care when a doctor certifies that you have a terminal illness and are expected to live six months or less. Hospice focuses on comfort and quality of life rather than curing the illness. Part A covers doctor visits, nursing care, medications related to your terminal condition, medical equipment, counseling, and respite care (temporary care to give your family a break).

You pay nothing for hospice services covered by Part A, except for a small copay on prescription drugs and inpatient respite care. You can receive hospice care at home, in a hospice facility, a hospital, or a nursing home. If you choose hospice, you give up the right to have Medicare pay for curative treatment of your terminal illness, though you can still receive treatment for other conditions. You can stop hospice care at any time and go back to regular Medicare coverage.

What Part A Does Not Cover

Part A does not cover outpatient care — visits to a doctor's office, emergency room visits, or lab work done outside a hospital. Those are covered by Medicare Part B. Part A also does not cover prescription drugs, dental care, vision care, hearing aids, or routine preventive services like screenings and vaccinations (those are covered by Part B). Long-term custodial care in a nursing home is not covered by Part A, even if the facility is called a nursing home.

Part A does not cover private duty nursing, a private room (unless medically necessary), or a television or telephone in your hospital room. It does not cover care provided by a family member, even if that family member is a nurse. If you travel outside the United States, Part A generally does not cover care you receive abroad, with rare exceptions for care in Canada or Mexico under specific circumstances.

How to Use Your Part A Coverage

When you are admitted to a hospital, the hospital will verify your Medicare coverage and handle the billing directly with Medicare. You do not need to file a claim — the hospital does that for you. You will receive a bill for your deductible and any coinsurance amounts you owe. Keep your Medicare card with you and bring it to every hospital or facility visit.

If you are discharged from the hospital and the hospital recommends skilled nursing or home health care, ask the discharge planner to refer you to a Medicare-approved facility or agency. The discharge planner can also explain what Part A will cover in your specific situation. If you have questions about what you owe, call the facility's billing department or call Medicare directly at 1-800-MEDICARE.

Frequently Asked Questions

Do I have to pay anything when I go to the hospital?

You pay the Part A deductible once per benefit period (in 2024, $1,676). After that, Part A covers all inpatient hospital costs for the first 60 days. If you stay longer, you pay a daily coinsurance amount. You may also owe copays for certain services like blood transfusions or emergency room visits.

What is the difference between a skilled nursing facility and a nursing home?

A skilled nursing facility provides medical care and therapy under a doctor's supervision. A nursing home may provide only custodial care — help with daily living. Part A covers skilled nursing facilities for up to 100 days after a hospital stay, but does not cover custodial-only care in a nursing home.

If I get home health care, do I have to pay anything?

No. Home health services ordered by a doctor and provided by a Medicare-approved agency are covered by Part A at no cost to you — no deductible, coinsurance, or copay. You must be homebound and the care must be skilled nursing or therapy.

Does Part A cover my prescription drugs?

No. Prescription drugs are covered by Medicare Part D (prescription drug coverage), which is separate from Part A. You must enroll in a Part D plan during your enrollment period, or you may face a late enrollment penalty if you sign up later.

Can Part A cover a hospital stay if I travel outside the United States?

Generally no. Part A does not cover care outside the United States, except in rare cases in Canada or Mexico under specific circumstances. If you travel, consider supplemental coverage or travel insurance that includes medical care abroad.