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

Part A is the hospital insurance piece of Medicare. It pays for inpatient hospital care — meaning you stay overnight — plus 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 automatic: you are enrolled when you turn 65 if you are already getting Social Security.

Part A does have costs when you use it. You pay a deductible each time you enter the hospital — the amount changes yearly, but it covers your first 60 days of a hospital stay. After 60 days, you pay a daily amount called coinsurance. The same deductible applies to each new hospital stay, even if they happen in the same year.

Part A is different from Part B (doctor visits and outpatient care) and Part D (prescription drugs). Many people have all three, but you can have Part A without the others. If you are still working at 65 and have health insurance through your job, you can delay Part A without penalty, though most people do not need to.

Key Takeaways

  • Part A covers overnight hospital stays, skilled nursing care after a hospital stay, hospice, and some home health visits — but not doctor office visits or prescription drugs.
  • You pay a deductible once per hospital stay (covering the first 60 days), then daily coinsurance amounts if you stay longer than 60 days.
  • Part A is free if you paid Medicare taxes for 10 years; enrollment is automatic at 65 if you are on Social Security.
  • Skilled nursing care is only covered if you were hospitalized first and admitted to the facility within three days of leaving the hospital.

What Part A actually pays for in the hospital

When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, and most tests and procedures done inside the hospital. It also covers blood transfusions, surgery, anesthesia, and medications given to you during your stay. You do not get a separate bill for these things — Part A negotiates the price with the hospital, and you pay only your deductible and coinsurance.

Part A does not cover private rooms unless medically necessary, and it does not cover a television or telephone in your room. If you want those extras, you pay out of pocket. Part A also does not cover the doctor who treats you in the hospital — that is covered by Part B, which is separate.

Skilled nursing facility care after hospitalization

If you need ongoing care after leaving the hospital — such as physical therapy, wound care, or help with daily activities — Part A may cover a stay in a skilled nursing facility. The key word is skilled: the facility must provide nursing or rehabilitation services that cannot be done at home. A regular assisted living facility does not count.

Part A will only pay if you meet three conditions: you were hospitalized for at least three consecutive days (not counting the day you left), you were admitted to the nursing facility within three days of leaving the hospital, and a doctor ordered the care. Part A covers the first 20 days with no cost to you. From day 21 to day 100, you pay a daily coinsurance amount. After day 100 in the same benefit period, you pay all costs yourself.

A benefit period starts the day you enter the hospital and ends 60 days after you leave the hospital or nursing facility, whichever is later. If you go back into the hospital after that 60-day window closes, a new benefit period begins and your deductible resets.

Home health care covered by Part A

Part A covers some home health services — skilled nursing visits, physical therapy, occupational therapy, and speech therapy — but only if you are homebound and a doctor orders the care. You must be unable to leave home except with difficulty, and the care must be skilled, not just help with daily tasks like bathing or cooking.

Home health care under Part A is free; you pay nothing for the visits themselves. However, if you need medical equipment like a wheelchair or oxygen, you may pay 20 percent of the cost after Part B's deductible is met. Home health agencies are not hospitals, so they bill Part A and Part B separately depending on what service they provide.

Hospice care for terminal illness

If you have a terminal illness and choose hospice care instead of treatment to cure the disease, Part A covers hospice services. These include nursing care, pain medication, counseling, and respite care (temporary relief for family caregivers). You pay nothing for hospice services themselves, though you may pay a small amount for medications and medical equipment.

To use hospice, your doctor must certify that you have six months or less to live. You do not have to use all six months at once — if you improve, you can leave hospice and return to regular Medicare coverage. If you need to return to hospice later, you can do that too. Hospice is about comfort and quality of life, not cure.

What Part A does not cover

Part A does not cover doctor visits, whether in the hospital or the office — that is Part B. It does not cover prescription drugs, even if you take them at home after a hospital stay — that is Part D. Part A does not cover long-term custodial care in a nursing home, meaning help with bathing, dressing, and eating when no skilled nursing is needed. It does not cover most outpatient services like lab work or imaging done at a clinic.

Part A also does not cover care outside the United States, except in very limited cases near the border. If you travel abroad, you will need separate travel insurance to cover medical emergencies.

Part A costs: deductible and coinsurance

Your main Part A cost is the deductible, which you pay once per benefit period when you enter the hospital. The deductible amount changes each year — it has been between $1,000 and $1,600 in recent years, but the exact amount depends on the current year. You can find the current deductible on Medicare.gov or by calling 1-800-MEDICARE.

If you stay in the hospital longer than 60 days, you pay a daily coinsurance amount for days 61 through 90. If you stay longer than 90 days, you have a limited number of "lifetime reserve days" — 60 total across your entire life — that Part A will cover at a higher daily coinsurance rate. After your lifetime reserve days are used, you pay all hospital costs yourself.

For skilled nursing facilities, you pay nothing for days 1 through 20, then a daily coinsurance amount for days 21 through 100. These costs reset with each new benefit period, so if you have a new hospital stay after 60 days, your nursing home costs start over at zero.

Frequently Asked Questions

Do I have to pay for Part A if I am still working at 65?

No. Part A is free if you or your spouse paid Medicare taxes for 10 years. You are enrolled automatically at 65 even if you are still working. If you have health insurance through your job, you can keep it and use Part A as backup, or you can delay Part A without penalty as long as you are actively employed and covered by your employer's plan.

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

After 90 days, Part A covers only your lifetime reserve days — you have 60 of these total across your entire life. Once you use them, you pay all hospital costs yourself. These reserve days do not reset each year; they are a one-time pool. Many people buy supplemental insurance (Medigap) to cover costs after Part A runs out.

Does Part A cover a nursing home if I do not go to the hospital first?

No. Part A only covers skilled nursing facilities if you were hospitalized for at least three consecutive days first and admitted to the facility within three days of leaving the hospital. If you go directly to a nursing home from home, Part A does not pay. You would need to pay privately or use Medicaid if you meet income limits.

Can I use Part A if I live outside the United States?

Part A generally does not cover care outside the U.S., with rare exceptions for care near the U.S. border in Canada or Mexico. If you live abroad permanently, you may lose Part A coverage. If you travel internationally, you will need separate travel insurance for medical emergencies.

What is the difference between Part A and Medigap insurance?

Part A is government insurance that covers hospital and skilled nursing care. Medigap is private supplemental insurance you buy to cover costs that Part A does not — like deductibles and coinsurance. Medigap helps with Part A and Part B costs but does not replace either one.