Medicare Part A covers hospital stays, skilled nursing care, and hospice

Medicare Part A is hospital insurance. It pays for inpatient hospital care, stays in a skilled nursing facility after a hospital stay, some home health services, and hospice care. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes while working for at least 10 years. Part A is automatic — you are enrolled when you turn 65 if you are already getting Social Security.

Part A has a deductible you pay once per benefit period (usually a hospital stay lasting up to 60 days). After that, Medicare covers most of the cost. You may also pay coinsurance — a daily amount — if your stay is longer than a certain number of days. The exact amounts change each year.

Key Takeaways

  • Part A covers inpatient hospital stays, skilled nursing facility care after hospitalization, home health services, and hospice — but not outpatient doctor visits or prescription drugs.
  • You pay a deductible per benefit period and coinsurance for longer stays, but no monthly premium if you worked and paid Medicare taxes for at least 10 years.
  • A benefit period starts when you enter the hospital and ends 60 days after you leave — you can have more than one benefit period in a year.
  • Part A does not cover custodial care (help with bathing, dressing, eating) unless it is part of skilled nursing care ordered by a doctor.

What Part A actually pays for in a hospital

When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications, and lab tests. It also covers blood transfusions, surgery, and anesthesia. You stay as an inpatient when a doctor orders you admitted — sitting in an emergency room or observation unit does not count as inpatient, even if you spend the night.

Part A does not cover private duty nursing, a private room (unless medically necessary), or a television or phone in your room. If you want those extras, you pay out of pocket. Part A also does not cover experimental treatments or procedures deemed not medically necessary.

Skilled nursing facility care after you leave the hospital

If you need ongoing care after a hospital stay — physical therapy, wound care, or help regaining strength — Part A may cover a stay in a skilled nursing facility. You must have been admitted to a hospital for at least three consecutive days (not counting the day you leave), and a doctor must order the skilled nursing care within 30 days of leaving the hospital.

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 amount (which changes yearly). After day 100, you pay all costs. The facility must be Medicare-certified, and the care must be skilled — meaning it requires a nurse or therapist, not just help with daily activities.

Home health services covered by Part A

Part A covers home health care when a doctor orders it and you are homebound — meaning leaving home is difficult or medically inadvisable. The care must be skilled, such as nursing visits, physical therapy, or occupational therapy. A home health agency must be Medicare-certified.

Part A covers the visits themselves, medical equipment (like oxygen or a walker), and supplies. You pay nothing for these services. Part A does not cover homemaker services, meal delivery, or help with housecleaning unless those services are part of a skilled care plan — for example, a nurse teaching you how to manage medications while in your home.

Hospice care for terminal illness

Part A covers hospice care when a doctor certifies that you have a terminal illness and six months or less to live. Hospice focuses on comfort and quality of life rather than cure. Part A covers doctor visits, nursing care, pain medication, counseling, and respite care (temporary relief for your caregiver).

You pay nothing for hospice services covered by Medicare. You may pay a small coinsurance for prescription drugs and inpatient respite care. You can change your mind about hospice — if you decide to pursue treatment instead, you can leave the hospice benefit and use your other Medicare coverage.

What Part A does not cover

Part A does not cover outpatient care — doctor visits in a clinic or office, emergency room visits that do not lead to admission, or same-day surgery centers. Those are covered by Medicare Part B. Part A also does not cover prescription drugs; that is Medicare Part D. Dental, vision, hearing aids, and long-term custodial care (help with bathing, dressing, eating) are not covered by any part of Original Medicare.

Part A does not cover care in a facility that is not Medicare-certified, or care ordered by a doctor who is not accepting Medicare. If you go to a hospital or facility that does not accept Medicare, you may have to pay the full bill yourself.

How the deductible and coinsurance work

Each year, Part A has a deductible — a flat amount you pay before Medicare starts paying. This deductible applies per benefit period, not per calendar year. A benefit period begins when you enter a hospital and ends 60 days after you are discharged. If you are readmitted after that 60-day window, a new benefit period starts and a new deductible applies.

After you meet the deductible, Medicare covers all inpatient hospital costs for days 1 through 60 of your stay. For days 61 through 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you can use lifetime reserve days — 60 additional days Medicare will cover in your lifetime, though you pay coinsurance for those too. The exact dollar amounts for the deductible and coinsurance change each January.

Frequently Asked Questions

Do I have to pay for Part A if I did not work 10 years?

If you did not pay Medicare taxes for 10 years, you can still buy Part A, but you will pay a monthly premium. The premium is higher if you worked fewer than 30 quarters (roughly 7.5 years). Contact Social Security to find out your work history and what your premium would be.

What is the difference between inpatient and observation status?

Inpatient means a doctor has formally admitted you to the hospital. Observation means you are being monitored but not admitted — you might spend the night but still be considered outpatient. This matters because Part A only covers inpatient stays. If you are unsure of your status, ask the hospital staff directly.

Can Part A cover me if I travel outside the United States?

Part A generally does not cover care outside the U.S., except in very limited cases — for example, if you are in Canada or Mexico and need emergency care. If you travel frequently, you may want to look into supplemental coverage that includes international care.

What happens if I do not have Part A when I turn 65?

If you do not sign up for Part A when you are first may be able to access, you may have to pay a penalty — a higher premium — for as long as you have Medicare. The exception is if you are still working and covered by your employer's health plan; in that case, you can delay without penalty.

Does Part A cover mental health or substance use treatment?

Part A covers inpatient mental health and substance use treatment in a hospital the same way it covers other inpatient care — you pay the deductible and coinsurance. Outpatient mental health visits are covered by Part B, not Part A.