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

Medicare Part A is hospital insurance. It pays for care you receive as an inpatient — meaning you are admitted to a hospital or facility overnight — rather than care you receive as an outpatient in a doctor's office or emergency room. Part A also covers skilled nursing facilities, hospice care, and limited home health visits when ordered by a doctor.

Most people age 65 and older do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working. If you did not work long enough to may have access to for premium-free Part A, you can buy it. Part A does have a deductible and copayments that you pay when you use the services.

Key Takeaways

  • Part A covers the full cost of your hospital room, meals, and basic nursing care for the first 60 days of each hospital stay after you pay the annual deductible.
  • Skilled nursing facility care is covered for up to 100 days per benefit period if you were hospitalized first and meet other requirements, with copayments starting on day 21.
  • Part A covers hospice care for people with a terminal illness, including medications for pain and symptom relief, but not all hospice providers accept Medicare.
  • Home health services such as nursing visits and physical therapy are covered when a doctor orders them and you are homebound, with no copayment required.
  • Part A does not cover outpatient services, prescription drugs, dental care, vision care, hearing aids, or long-term custodial care in a nursing home.

Hospital inpatient stays and what Part A pays

When you are admitted to a hospital as an inpatient, Part A covers your semiprivate room, meals, nursing care, medications given in the hospital, lab tests, X-rays, and medical equipment like oxygen or wheelchairs. It does not cover a private room unless medically necessary, and it does not cover the cost of a television or telephone in your room.

For each benefit period, you pay a deductible before Part A begins to pay. A benefit period starts the day you enter the hospital and ends 60 days after you leave without receiving any inpatient hospital or skilled nursing care. If you are readmitted within 60 days, you are still in the same benefit period and do not pay another deductible.

After you pay the deductible, Part A covers all inpatient hospital costs for days 1 through 60 of your stay. On days 61 through 90, you pay a copayment per day. If you need to stay longer than 90 days, you can use your lifetime reserve days — 60 additional days that Medicare sets aside for you over your lifetime. You pay a higher copayment for each reserve day you use, and once you use them, they do not come back.

Skilled nursing facility care after hospitalization

Part A covers care in a skilled nursing facility (SNF) — a facility that provides skilled nursing and rehabilitation services — but only if you meet specific conditions. You must have been hospitalized for at least three consecutive days (not counting the day you were discharged), you must be admitted to the SNF within 30 days of leaving the hospital, and a doctor must order the care for a condition related to the reason you were hospitalized.

Part A covers all costs for the first 20 days of SNF care in each benefit period. From day 21 through day 100, you pay a copayment per day. After day 100, Part A does not pay, and you are responsible for all costs. Many people assume a nursing home stay is covered by Medicare; it is not unless the care is skilled nursing or rehabilitation ordered by a doctor, and only for the time limits described above.

Hospice care for terminal illness

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 managing pain rather than curing the illness. Part A covers doctor visits, nursing care, medications for pain and symptom relief, counseling, and respite care (short-term inpatient care to give your family a break).

You pay nothing for hospice services covered by Medicare, though you may pay a small copayment for medications and respite care. You must choose hospice care instead of other Medicare-covered treatments for your terminal illness — you cannot receive both curative treatment and hospice at the same time for the same condition. If your condition improves and you no longer meet the hospice criteria, you can leave the hospice program and return to regular Medicare coverage.

Home health services with no copayment

Part A covers home health services when a doctor orders them, you are homebound (meaning leaving home requires considerable effort), and you need skilled care such as nursing, physical therapy, occupational therapy, or speech therapy. Services covered include wound care, injections, physical therapy, occupational therapy, and speech therapy. Home health aides who help with bathing and dressing are covered only if you also need skilled care.

You pay nothing for home health services covered by Part A — there is no copayment or deductible. However, if you need durable medical equipment such as a wheelchair or oxygen, you pay 20 percent of the approved amount after you meet your Part B deductible. Home health services are not the same as custodial care or long-term care; they are temporary services ordered by a doctor for a specific medical need.

What Part A does not cover

Part A does not cover outpatient services — care you receive without being admitted to the hospital overnight. This includes emergency room visits, urgent care, doctor office visits, lab work ordered by your doctor's office, and X-rays taken outside a hospital. Those services are covered by Medicare Part B, which is medical insurance.

Part A also does not cover prescription drugs you take at home, dental care, vision care, hearing aids, or long-term custodial care in a nursing home. Custodial care means help with daily activities like bathing, dressing, and eating when that is the only care you need — not skilled nursing or therapy. If you need long-term nursing home care, you pay for it yourself, through Medicaid (if you meet income and asset limits), or through long-term care insurance if you have it.

Understanding your costs and the benefit period

Your costs under Part A depend on the type of care and how long you receive it. The deductible amount changes each year. Once you meet the deductible in a benefit period, Part A covers all inpatient hospital costs for the first 60 days. Copayments explore for days 61 through 90 and for lifetime reserve days. Skilled nursing facility copayments start on day 21 and continue through day 100.

A benefit period is the way Medicare groups your hospital and skilled nursing care. It begins when you enter the hospital and ends 60 days after you leave without receiving inpatient care. If you are readmitted within those 60 days, you are still in the same benefit period. If you are readmitted after 60 days have passed, a new benefit period begins and you pay a new deductible. You can have more than one benefit period in a year if you are hospitalized multiple times.

Questions to ask your doctor or Medicare

Before you are admitted to the hospital or a skilled nursing facility, ask your doctor whether the care is inpatient or outpatient, how many days you are expected to stay, and whether the care will be covered by Part A. If you are being discharged to a skilled nursing facility, ask whether the facility accepts Medicare and whether your care meets the three-day hospitalization requirement.

If you receive a bill you think Part A should have covered, contact Medicare at 1-800-MEDICARE to ask why the claim was denied. You have the right to request an explanation and to appeal if you disagree with the decision. Keep copies of all hospital bills and discharge papers so you can compare them to what Medicare paid.

Frequently Asked Questions

Does Part A cover an emergency room visit?

No. Emergency room visits are outpatient services covered by Part B, not Part A. Part A only covers care when you are admitted to the hospital as an inpatient. If the emergency room visit leads to a hospital admission, Part A begins to cover your costs once you are admitted.

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

After 90 days, you can use your lifetime reserve days — 60 additional days that Medicare sets aside for you. You pay a higher copayment for each reserve day. Once you use all 60 reserve days over your lifetime, Medicare stops paying and you are responsible for all costs.

Does Part A cover a nursing home if I need long-term care?

Part A covers skilled nursing facility care for up to 100 days per benefit period only if you were hospitalized first and a doctor orders the care for rehabilitation or skilled nursing. It does not cover long-term custodial care — help with daily activities when you do not need skilled nursing or therapy. Long-term nursing home care is your responsibility unless you have long-term care insurance or meet Medicaid income limits.

Do I have to pay anything for home health services?

No copayment is required for home health nursing and therapy services covered by Part A. You may pay 20 percent of the cost of durable medical equipment like wheelchairs or oxygen after you meet your Part B deductible, but the nursing visits themselves are covered at no cost.

Can I use Part A to cover prescription drugs I take at home?

No. Part A does not cover prescription drugs. Prescription drug coverage is provided through Medicare Part D, which is a separate insurance plan you can choose. Some people get drug coverage through a Medicare Advantage plan instead.