Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services
Medicare Part A is hospital insurance. It pays for care you receive as an inpatient — meaning you are admitted to a facility and stay overnight — rather than care you receive as an outpatient in a doctor's office or emergency room. Part A covers four main types of care: hospital stays, skilled nursing facilities, hospice care, and some home health services. 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.
Part A is not automatic coverage for all medical bills. It has specific rules about what counts as inpatient care, how long you can stay, and what you pay out of pocket. Understanding these boundaries matters because a bill that looks like it should be covered often is not, and costs can be steep when you hit the limits.
Key Takeaways
- Part A covers inpatient hospital stays after you pay a deductible, then covers most costs for up to 60 days per benefit period.
- Skilled nursing facility care is covered only after a hospital stay of at least three days, and only for up to 100 days per benefit period.
- Hospice care is covered for people with a terminal diagnosis, and Part A pays for almost all costs including medications and equipment related to the terminal condition.
- Home health services are covered only if a doctor orders them, you are homebound, and the care is skilled nursing or therapy — not custodial help like bathing or cleaning.
- Part A has no coverage for outpatient care, preventive services, or long-term custodial care in a nursing home.
Hospital stays and what you pay
Part A covers inpatient hospital care after you meet the deductible. For 2024, the deductible is $1,632 per benefit period — a benefit period starts the day you enter the hospital and ends 60 days after you leave. If you are readmitted within that 60-day window, you do not pay a second deductible. If you are readmitted after 60 days have passed, a new benefit period begins and you pay the deductible again.
Once you have paid the deductible, Part A covers all inpatient hospital costs for days 1 through 60 of each benefit period. After day 60, you pay a daily coinsurance amount — for 2024, that is $408 per day for days 61 through 90. If you stay longer than 90 days, Part A covers an additional 60 "lifetime reserve days" at a higher coinsurance rate of $816 per day. These lifetime reserve days are not renewable; once you use them, they are gone.
Part A does not cover outpatient hospital services. If you go to a hospital emergency room but are not admitted as an inpatient, Part A does not pay. If you receive outpatient surgery, diagnostic tests, or imaging at a hospital, Part A does not cover it — that is where Medicare Part B (medical insurance) comes in.
Skilled nursing facility care after hospitalization
Part A covers care in a skilled nursing facility, but only under strict conditions. You must have been an inpatient in a hospital for at least three consecutive days before entering the facility. The three-day stay must be for the same condition or a related condition that led to the nursing facility admission. A three-day stay that ends, you go home for a day, then you enter a nursing facility does not count — the hospital stay and facility admission must be connected.
Once you meet the three-day requirement, Part A covers up to 100 days per benefit period. You pay nothing for days 1 through 20. For days 21 through 100, you pay a daily coinsurance of $204 per day (for 2024). After day 100, Part A stops paying and you are responsible for all costs. Many people assume Medicare covers long-term nursing home care; it does not. Part A covers only short-term skilled care — physical therapy, occupational therapy, skilled nursing, or medical monitoring — not custodial care like help with bathing, dressing, or meals.
The facility must be a Medicare-certified skilled nursing facility, not just any nursing home. Some facilities are certified; others are not. Before admission, ask the hospital discharge planner or the facility itself whether it is Medicare-certified and whether your care will be covered.
Hospice care for terminal illness
Part A covers hospice care for people with a terminal diagnosis — typically a life expectancy of six months or less. A doctor must certify the diagnosis, and you must choose hospice care instead of curative treatment. Unlike hospital or nursing facility care, hospice is usually provided at home, though Part A also covers inpatient hospice stays when needed for pain management or symptom control.
Part A covers almost all hospice costs: nursing care, doctor visits, medications, medical equipment, counseling, and aide services. You pay nothing for hospice services related to your terminal condition. You may pay a small copay — up to $5 — for medications and medical supplies, but many hospice organizations waive this. Part A does not cover room and board if you are in a hospice facility, and it does not cover care unrelated to your terminal diagnosis.
Choosing hospice does not mean you cannot change your mind. You can stop hospice care at any time and return to curative treatment, though you would then lose hospice coverage. If your condition improves and you live longer than expected, Part A continues to cover hospice care.
Home health services and the homebound requirement
Part A covers home health services — skilled nursing, physical therapy, occupational therapy, and speech therapy — but only if three conditions are met. First, a doctor must order the services and determine that you need them. Second, you must be homebound, meaning you cannot leave home without considerable difficulty or the help of another person. Third, the services must be skilled care, not custodial help.
Homebound does not mean you never leave your house. It means leaving requires a major effort — you might leave for a doctor's appointment or religious services with help, but you cannot go out for errands or social activities on your own. If you can walk to the mailbox or drive yourself to the grocery store, you are probably not homebound by Medicare's definition.
Part A covers the skilled services themselves at no cost to you, but you pay nothing for home health services — there is no deductible or coinsurance. However, if you need medical equipment like a wheelchair or oxygen, Part B (not Part A) covers that, and you would pay 20 percent coinsurance after meeting the Part B deductible. Part A does not cover housekeeping, meal preparation, or personal care like bathing — those are custodial services, not skilled care.
What Part A does not cover
Part A does not cover outpatient care of any kind. Doctor's office visits, emergency room visits that do not result in admission, lab tests, imaging, and preventive services like screenings and vaccinations are not Part A benefits. These fall under Part B or other Medicare coverage.
Part A does not cover long-term custodial care in a nursing home. If you need help with daily living activities but do not need skilled medical care, Part A will not pay. Private pay, Medicaid, or long-term care insurance would cover this, but Medicare Part A does not.
Part A does not cover private room upgrades, television, or telephone charges. It does not cover experimental treatments or care outside the United States. It does not cover dental care, vision care, hearing aids, or routine foot care. If you need these services, you would need to pay out of pocket or have supplemental coverage.
Benefit periods and how they reset
A benefit period is the way Medicare measures your coverage year for Part A. It is not the same as a calendar year. A benefit period begins the day you enter a hospital or skilled nursing facility as an inpatient and ends 60 days after you leave. If you do not use any inpatient services for 60 days, the benefit period ends and a new one begins the next time you are admitted.
This matters because your deductible, your days of coverage, and your lifetime reserve days all reset with each new benefit period — except for lifetime reserve days, which do not renew. If you use 30 days of hospital coverage in one benefit period and are readmitted 90 days later, you start a new benefit period with a fresh deductible and 60 new days of coverage. But if you have already used all 60 of your lifetime reserve days in a previous benefit period, those do not come back.
Frequently Asked Questions
Does Part A cover an emergency room visit?
Part A covers emergency room care only if you are admitted to the hospital as an inpatient. If you are treated and released, Part B covers the emergency room visit, not Part A. You pay the Part B deductible and then 20 percent coinsurance.
What is the difference between skilled nursing and custodial care?
Skilled nursing requires a nurse or therapist and includes wound care, medication management, physical therapy, or medical monitoring. Custodial care is help with daily living — bathing, dressing, eating, toileting — and does not require a medical professional. Part A covers skilled care; it does not cover custodial care.
If I use all 60 days of hospital coverage, what happens?
After 60 days, you can use lifetime reserve days at a higher coinsurance rate ($816 per day for 2024). You have 60 lifetime reserve days total across your entire life. Once they are used, Part A stops paying for hospital stays, and you pay all costs yourself.
Can Part A cover a nursing home stay that is not after a hospital stay?
No. Part A covers skilled nursing facility care only after a may have access to hospital stay of at least three consecutive days. If you enter a nursing home directly from home or from an outpatient setting, Part A does not cover it. You would need to pay privately or use Medicaid if you may have access to.
Does Part A cover medications?
Part A covers medications only while you are an inpatient in a hospital or skilled nursing facility, or if you are receiving hospice care. Medications you take at home are covered by Part D (prescription drug coverage), not Part A.