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

Part A is the hospital insurance portion of Original Medicare. 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 at a doctor's office or emergency room visit where you go home the same day. Part A also covers skilled nursing facilities (nursing homes that provide medical care), hospice services for people nearing the end of life, and limited home health services when ordered by a doctor.

Part A is automatic. When you turn 65 and sign up for Medicare, you are enrolled in Part A whether you choose it or not. 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 monthly cost varies based on how many years you or your spouse worked.

Understanding what Part A covers — and what it does not — matters because the gaps are where your out-of-pocket costs appear. Part A has a deductible you pay once per benefit period, and after that deductible, Medicare covers most of the cost. But the coverage is not unlimited, and it depends on how long you stay.

Key Takeaways

  • Part A covers the full cost of inpatient hospital care after you pay a single deductible per benefit period, which resets after 60 days without a hospital stay.
  • Skilled nursing facility care is covered for up to 100 days per benefit period, but only if you were hospitalized for at least three days first and only for conditions related to that hospital stay.
  • You pay nothing for the first 20 days in a skilled nursing facility, then a daily copay for days 21 through 100, after which you pay all costs.
  • Part A does not cover custodial care (help with bathing, dressing, or daily living) in a nursing home, only skilled medical care like wound care or physical therapy.
  • Home health services covered by Part A must be ordered by a doctor and require that you are homebound; routine check-ups or non-medical help at home are not covered.

What Part A Covers in a Hospital

When you are admitted to a hospital as an inpatient under Part A, Medicare covers a semiprivate room (two beds, not a private room unless medically necessary), all meals, nursing care, medications given in the hospital, lab tests, X-rays, and surgery. It also covers blood transfusions, operating room costs, and intensive care if you need it. Essentially, Part A covers the facility and the services provided inside it.

You pay a deductible once per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave without being readmitted. If you go home, stay out of the hospital for 60 days, and then return, a new benefit period begins and you pay the deductible again. The deductible amount changes each year; you can find the current year's amount on Medicare.gov.

After you pay the deductible, Medicare covers all inpatient hospital costs for days 1 through 60 of your stay. On days 61 through 90, you pay a daily copay. If you stay longer than 90 days, you can use "lifetime reserve days" — 60 additional days Medicare sets aside for your entire life. You pay a higher daily copay for reserve days, and once you use them, they are gone forever.

Skilled Nursing Facility Coverage and Limits

Part A covers care in a skilled nursing facility (SNF) — a nursing home licensed to provide medical care — but only under specific conditions. You must have been hospitalized for at least three consecutive days when ready before entering the SNF, and you must be admitted to the SNF within 30 days of leaving the hospital. The care you receive in the SNF must be for the same condition you were hospitalized for, or a condition that developed during your hospital stay.

Coverage is limited to 100 days per benefit period. For the first 20 days, Part A covers all costs after you pay nothing additional. On days 21 through 100, you pay a daily copay (the amount changes yearly). After day 100, you pay all costs yourself. Many people think "skilled nursing facility" means any nursing home, but it specifically means a facility providing skilled care — wound care, physical therapy, intravenous medications, or other medical services — not custodial care like help with bathing or dressing.

If you need custodial care only (information with activities of daily living), Part A does not cover it, even in a nursing home. This is one of the largest gaps in Part A coverage and a reason many seniors buy supplemental insurance or long-term care insurance.

Home Health Services Covered by Part A

Part A covers home health services when a doctor orders them and you meet specific conditions. You must be homebound — meaning leaving home requires considerable effort and is medically contraindicated, or you are unable to leave without help. The services must be skilled care: nursing visits, physical therapy, occupational therapy, speech therapy, or medical social work. Part A does not cover routine check-ups, non-medical help at home (like housekeeping or meal preparation), or ongoing care that is not skilled.

Home health visits covered by Part A are free — you pay nothing, and there is no deductible or copay. However, if you receive durable medical equipment (a wheelchair, oxygen, a hospital bed) through the home health agency, you may pay 20 percent of the approved amount after Part A's deductible. Home health coverage continues as long as the doctor's order remains in place and you continue to meet the homebound requirement.

Hospice Care Under Part A

Part A covers hospice care for people with a terminal illness when a doctor certifies that the person has six months or less to live. Hospice focuses on comfort and symptom management rather than cure. Part A covers hospice services at home, in a hospice facility, in a hospital, or in a nursing home. Coverage includes nursing care, doctor visits, medications related to the terminal illness, counseling, and respite care (temporary relief for the family caregiver).

You pay nothing for hospice services covered by Part A, though you may pay a small copay (usually $5) for medications and a daily copay for respite care. If you choose hospice, you are agreeing to stop pursuing curative treatment for the terminal condition, though you can still receive treatment for other conditions. You can leave hospice at any time and return to regular Medicare coverage.

What Part A Does Not Cover

Part A does not cover outpatient services — doctor visits, emergency room visits where you are not admitted, lab work done outside a hospital, or imaging like CT scans at an outpatient center. Those are covered by Part B, which is medical insurance. Part A also does not cover custodial care in any setting, private duty nursing (a nurse hired to care for you at home), or non-skilled information with daily living.

Part A does not cover a private hospital room unless it is medically necessary. It does not cover personal comfort items like a television or telephone in your hospital room, and it does not cover experimental treatments. Dental care, vision care, hearing aids, and routine physical exams are not covered by Part A (or by Part B, for that matter — those require separate coverage).

Understanding Your Out-of-Pocket Costs

Your costs under Part A depend on what service you use and how long you use it. For a hospital stay, you pay one deductible per benefit period, then nothing until day 61. For a skilled nursing facility, you pay nothing for days 1 through 20, then a daily copay for days 21 through 100. For home health and hospice, you typically pay nothing. If you need blood transfusions, you pay for the first three pints; Medicare covers the rest.

Many seniors buy Medigap (supplemental insurance) or Medicare Advantage (Part C, an alternative to Original Medicare) partly to cover Part A's deductibles and copays. Medigap plans are sold by private insurers and cover some or all of the costs Medicare does not. Medicare Advantage plans are offered by private insurers and bundle Part A, Part B, and usually Part D (prescription drugs) into one plan, often with lower out-of-pocket costs but a narrower network of doctors.

When to Contact Medicare or Your Doctor

Contact Medicare if you receive a bill for a service you believe Part A should have covered, or if you are unsure whether a recommended procedure or facility stay will be covered. You can call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov. Have your Medicare card and the details of the service handy.

Talk to your doctor before entering a hospital or skilled nursing facility about what Part A will and will not cover for your specific situation. Ask whether the facility is Medicare-certified and whether your condition meets the requirements for coverage. If you are considering a long-term stay in a nursing home, ask your doctor and the facility about the difference between skilled care (covered by Part A) and custodial care (not covered), because this distinction determines what you will pay.

Frequently Asked Questions

Does Part A cover a hospital stay for observation?

No. Observation status means you are in the hospital but not admitted as an inpatient. Part A does not cover observation stays; Part B covers the doctor's services and some facility costs. This distinction matters because it affects whether you can move to a skilled nursing facility afterward (you need three days as an inpatient, not observation). Ask the hospital to clarify your status when you arrive.

What happens if I stay in a skilled nursing facility longer than 100 days?

After 100 days in a skilled nursing facility per benefit period, Part A coverage ends and you pay all costs yourself. Some people buy long-term care insurance to cover this gap. Others rely on Medicaid if their income and assets are low enough, though Medicaid rules vary by state.

If I am readmitted to the hospital 30 days after leaving a skilled nursing facility, do I pay the deductible again?

Yes. If you have been out of the hospital for 60 days, a new benefit period begins and you pay the deductible again. If you are readmitted within 60 days, you are still in the same benefit period and do not pay another deductible, but you may owe copays depending on which day of your stay you are on.

Does Part A cover rehabilitation after a stroke or injury?

Part A covers rehabilitation in a skilled nursing facility if you were hospitalized for at least three days first and enter the facility within 30 days of discharge. The rehabilitation must be for a condition related to your hospital stay. Outpatient rehabilitation (physical therapy at a clinic) is covered by Part B, not Part A.

Can I use Part A to pay for a nursing home if I just need help with daily living?

No. Part A covers only skilled nursing care, not custodial care like bathing, dressing, or meal preparation. If you need custodial care in a nursing home, you pay out of pocket, use long-term care insurance if you have it, or may eventually may have access to for Medicaid depending on your state and financial situation.