Medicare Part A covers hospital stays, skilled nursing care, and hospice — but not all of the bill

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. Part A does not pay for doctor visits, outpatient care, prescription drugs, or long-term custodial care in a nursing home. You pay a deductible before Part A starts paying, and you pay coinsurance (a percentage of costs) for longer stays.

Part A is automatic for most people at 65 if they have worked and paid Medicare taxes. You do not pay a monthly premium for Part A if you or your spouse paid Medicare taxes for at least 10 years. If you did not work long enough, you can buy Part A, but the premium is higher.

Key Takeaways

  • Part A covers inpatient hospital stays after you pay a deductible, but you pay coinsurance for days 61 and beyond in the same hospital stay.
  • Part A covers up to 100 days in a skilled nursing facility after a may have access to hospital stay, with you paying coinsurance starting on day 21.
  • Part A covers some home health services if a doctor orders them and you are homebound, but not custodial care or help with daily living alone.
  • Part A does not cover doctor visits, outpatient procedures, prescription drugs, or long-term nursing home care without other insurance.
  • The Part A deductible and coinsurance amounts change each year, so check your Medicare summary letter or call Medicare to confirm current costs.

What Part A pays for inpatient hospital stays

When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, lab tests, imaging, and medications given in the hospital. It also covers blood transfusions, operating room costs, and anesthesia. Part A does not cover a private room unless medically necessary, and it does not cover a television or telephone in your room.

You pay a deductible once per benefit period before Part A pays anything. A benefit period starts when you enter the hospital and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. If you are readmitted after that 60-day break, a new benefit period begins and you pay the deductible again.

After you pay the deductible, Part A covers all approved hospital costs for days 1 through 60. On days 61 through 90, you pay a daily coinsurance amount and Part A pays the rest. If you 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 daily coinsurance for reserve days. Once you use a reserve day, you cannot get it back.

What Part A pays for skilled nursing facility care

Part A covers a stay in a skilled nursing facility (SNF) only if you were admitted to a hospital first and stayed at least three days, and only if you are admitted to the SNF within 30 days of leaving the hospital. The care must be for a condition related to your hospital stay, and it must be skilled care — not just help with daily living.

Skilled care means nursing care or physical, occupational, or speech therapy that only a trained professional can provide. Help with bathing, dressing, or meals alone is not skilled care. Part A covers days 1 through 20 in full. On days 21 through 100, you pay a daily coinsurance amount and Part A pays the rest. After day 100 in the same benefit period, Part A pays nothing and you pay all costs.

Many people think Medicare covers long-term nursing home care. It does not. Part A covers only the skilled nursing facility stay after a hospital stay, up to 100 days per benefit period. If you need ongoing care after those 100 days, you must pay out of pocket, use Medicaid if you may have access to, or have a long-term care insurance policy.

What Part A pays for home health services

Part A covers home health services if a doctor orders them, you are homebound (meaning you cannot leave home without help or great difficulty), and you need skilled care or therapy. Covered services include nursing visits, physical therapy, occupational therapy, speech therapy, and medical social work. Part A also covers medical equipment like oxygen, wheelchairs, and hospital beds ordered by your doctor.

You pay nothing for home health services covered by Part A — no deductible, no coinsurance. Part A pays the home health agency directly. However, Part A does not cover help with daily living, meals, housekeeping, or personal care unless it is part of a skilled nursing or therapy visit. If you need only custodial care, Part A does not pay.

What Part A pays for hospice care

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 managing pain rather than curing the illness. Part A covers doctor visits, nursing care, pain medication, counseling, and some medications and medical equipment related to your terminal condition.

You pay nothing for hospice services covered by Part A. You may pay a small coinsurance for prescription drugs and inpatient respite care (a short hospital stay to give your caregiver a break), but costs are minimal. If you choose hospice, you are saying you want comfort care instead of curative treatment, and Part A will not pay for treatments meant to cure your illness.

What Part A does not cover

Part A does not cover doctor visits, whether in the hospital or outpatient. That is Part B's job. Part A does not cover outpatient surgery, emergency room visits, urgent care, or diagnostic tests done outside the hospital. Part A does not cover prescription drugs you take at home — that is Part D. Part A does not cover dental care, vision care, hearing aids, or routine physical exams.

Part A does not cover custodial care in a nursing home — help with bathing, dressing, eating, and toileting when no skilled care is needed. It does not cover assisted living facilities or adult day care. It does not cover care in your home if you do not need skilled nursing or therapy. If you need long-term custodial care, you must pay out of pocket, use Medicaid if you may have access to, or have a long-term care insurance policy.

How much you pay out of pocket with Part A

Your costs with Part A depend on what type of care you receive and how long you stay. For a hospital stay, you pay a deductible and then coinsurance if you stay longer than 60 days. For a skilled nursing facility, you pay coinsurance starting on day 21. For home health and hospice, you typically pay nothing if the services are covered by Part A.

The deductible and coinsurance amounts change each year. Your Medicare Summary Notice, mailed in the fall, shows the current amounts. You can also call Medicare at 1-800-MEDICARE to ask what you will owe for a specific type of care. If you have a Medigap or Medicare Advantage plan, that plan may pay some or all of your Part A costs, so check your plan documents.

Questions to ask your doctor or Medicare

Before a hospital stay or admission to a skilled nursing facility, ask your doctor whether the care is inpatient or outpatient, because Part A only covers inpatient care. Ask whether your hospital stay will likely be long enough that you will owe coinsurance. If you are being discharged to a skilled nursing facility, ask whether it is a Medicare-approved facility and whether your stay will be covered.

If you are unsure whether a service is covered by Part A, call Medicare at 1-800-MEDICARE before you receive the care. Ask specifically what you will owe out of pocket. If you receive a bill you think is wrong, ask the provider or hospital to explain the charges and how they relate to your Part A coverage.

Frequently Asked Questions

Does Part A cover my doctor's bill when I am in the hospital?

No. Part A covers the hospital's charges — your room, nursing, lab tests, and medications given in the hospital. Your doctor's bill is covered by Part B, not Part A. You will receive a separate bill from your doctor, and Part B will pay 80% of the approved amount after you meet your Part B deductible.

If I use my lifetime reserve days, can I get them back?

No. Lifetime reserve days are a one-time benefit. Once you use all 60 of them across your lifetime, they are gone. After that, you pay all hospital costs beyond day 90 of a single stay. This is why it is important to understand your options before a very long hospital stay.

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

Part A covers a skilled nursing facility for up to 100 days after a hospital stay, but only if you need skilled nursing or therapy. It does not cover long-term custodial care — help with daily living in a nursing home. If you need ongoing care after 100 days, you must pay out of pocket or use Medicaid if you may have access to.

What happens if I am in the hospital on January 1st when the deductible changes?

The deductible that applies depends on when you were admitted. If you were admitted before January 1st, you pay the old deductible. If you are admitted on January 1st or later, you pay the new deductible. A new benefit period can start even if you are still in the hospital from a previous admission.

Does Part A cover home health if I do not have a hospital stay first?

Yes. Home health does not require a hospital stay first. Your doctor can order home health directly if you are homebound and need skilled care or therapy. Part A will cover it with no deductible or coinsurance, as long as the home health agency is Medicare-approved and the care is medically necessary.