Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services
Part A is hospital insurance. 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 (same-day visits). Part A covers four main types of care: inpatient hospital stays, skilled nursing facility stays after a hospital stay, hospice care for terminal illness, 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 not the same as Part B, which covers doctor visits and outpatient services. Many people have both Part A and Part B, often called Original Medicare. Understanding what Part A covers — and what it does not — helps you know what out-of-pocket costs to expect and when you might need additional coverage.
Key Takeaways
- Part A covers the full cost of inpatient hospital care after you meet your deductible, which resets each benefit period.
- Skilled nursing facility care is covered only after a hospital stay of at least three consecutive days, and only for up to 100 days per benefit period.
- Part A covers hospice care for people with a terminal diagnosis, including medications and equipment related to the terminal condition.
- Home health services covered by Part A include nursing care, physical therapy, and medical equipment, but only if ordered by a doctor and provided by a Medicare-certified agency.
- You pay coinsurance (a daily cost-sharing amount) for days 21 through 100 in a skilled nursing facility, and nothing for the first 20 days after a three-day hospital stay.
Inpatient Hospital Care: What Part A Pays
When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications given during your stay, lab tests, X-rays, and medical equipment used in the hospital. It also covers blood transfusions and the cost of surgery and anesthesia. Part A does not cover the doctor's fee for performing the surgery — that is covered by Part B — but it covers the facility itself.
You pay a deductible for each benefit period (usually a calendar year, though Medicare defines it differently). Once you meet the deductible, Part A covers 100 percent of inpatient hospital costs for days 1 through 60. For days 61 through 90, you pay a daily coinsurance amount. If you stay longer than 90 days, you can use your lifetime reserve days — a one-time pool of 60 extra days — and pay a higher daily coinsurance. After that, you pay all costs yourself.
The deductible and coinsurance amounts change each year. Your hospital stay is counted in days, not nights. If you are admitted on Monday and discharged on Wednesday, that is three days, even if you spent only two nights in the hospital.
Skilled Nursing Facility Care After Hospital Discharge
Part A covers skilled nursing facility (SNF) care only if you meet three conditions: you spent at least three consecutive days in a hospital when ready before the SNF stay, you are admitted to the SNF within 30 days of hospital discharge, and the care you need is skilled care (nursing or rehabilitation) rather than custodial care (help with daily living). Custodial care — bathing, dressing, eating — is not covered by Medicare, even in a nursing home.
Part A covers the full cost of the first 20 days in a skilled nursing facility per benefit period. For days 21 through 100, you pay a daily coinsurance amount. After 100 days, you pay all costs yourself. The facility must be Medicare-certified for Part A to cover it. Not all nursing homes are certified for Medicare skilled care.
Many people confuse skilled nursing facilities with long-term care facilities. A skilled nursing facility is meant for short-term recovery after a hospital stay. If you need ongoing custodial care or long-term placement, that is not covered by Part A, and you will need to pay out of pocket or use Medicaid if you meet its income and asset limits.
Hospice Care for Terminal Illness
Part A covers hospice care for people with a diagnosis of six months or less to live, as certified by a doctor. Hospice focuses on comfort and quality of life rather than cure. Part A covers doctor visits, nursing care, medications related to the terminal condition, medical equipment and supplies, counseling, and respite care (short-term inpatient care to give the family a break).
You pay nothing for hospice services covered by Part A. You may pay a small copayment for medications and a daily coinsurance for respite care, but these amounts are minimal. Hospice can be provided in your home, a hospice facility, a hospital, or a nursing home. The hospice agency must be Medicare-certified.
If you choose hospice, you are saying you do not want curative treatment for the terminal condition. You can still receive treatment for other conditions. If your condition improves and you live longer than six months, you can leave hospice and return to regular Medicare coverage.
Home Health Services Covered by Part A
Part A covers home health services — nursing care, physical therapy, occupational therapy, speech therapy, and medical social services — when ordered by your doctor and provided by a Medicare-certified home health agency. You must be homebound, meaning leaving home requires considerable effort and is medically contraindicated. You do not need to have been hospitalized first to receive home health services covered by Part A, though many people do.
Part A covers the cost of the services themselves and medical equipment such as wheelchairs, walkers, and oxygen. You pay nothing for home health services covered by Part A. The agency bills Medicare directly. However, if you need custodial care — help with bathing or dressing — that is not covered by Medicare, even at home.
Home health is different from home care. Home care agencies that provide non-medical help with daily living are not covered by Medicare. If you need both skilled nursing (covered) and help with bathing (not covered), you may need to hire a private aide for the non-medical tasks.
What Part A Does Not Cover
Part A does not cover outpatient care — doctor visits, lab work, or imaging done outside a hospital. Those are covered by Part B. Part A does not cover custodial care, which is help with daily living rather than medical care. It does not cover private-duty nursing, a private room (unless medically necessary), or a television or telephone in your hospital room.
Part A does not cover long-term care or ongoing nursing home stays for people who do not need skilled care. It does not cover dental care, hearing aids, eyeglasses, or routine foot care. It does not cover care received outside the United States, except in limited cases in Canada and Mexico near the U.S. border.
If you need coverage for services Part A does not cover, you may want to consider a Medigap policy (supplemental insurance) or a Medicare Advantage plan (Part C), which combines Part A and Part B and often includes additional benefits.
Deductibles and Cost-Sharing for Part A
| Service | What You Pay |
|---|---|
| Hospital stay, days 1–60 | Deductible only (amount changes yearly) |
| Hospital stay, days 61–90 | Daily coinsurance amount |
| Hospital stay, lifetime reserve days | Higher daily coinsurance amount |
| Skilled nursing facility, days 1–20 | Nothing (after 3-day hospital stay) |
| Skilled nursing facility, days 21–100 | Daily coinsurance amount |
| Hospice | Small copayment for medications and respite care |
| Home health services | Nothing |
The exact dollar amounts for deductibles and coinsurance change each year. You can find the current amounts on Medicare.gov or by calling 1-800-MEDICARE. These amounts explore to Original Medicare (Part A and Part B). If you have a Medicare Advantage plan, your costs may be different.
Because costs shift annually, it is worth checking your costs before you are admitted to a hospital or facility. Knowing what you will owe helps you plan and budget for medical care.
Frequently Asked Questions
Do I have to pay a premium for Part A?
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, you may pay a premium. Some people pay a reduced premium. You can find out whether you owe a premium by checking your Medicare card or calling 1-800-MEDICARE.
What is the difference between a benefit period and a calendar year?
Medicare defines a benefit period as 60 consecutive days without a hospital stay. Your deductible resets when a new benefit period begins, not on January 1. This means you could have two deductibles in one calendar year if you are hospitalized twice with more than 60 days between stays.
If I stay in a skilled nursing facility for 100 days, do I have to pay for day 101?
Yes. Part A covers up to 100 days of skilled nursing facility care per benefit period. After day 100, you pay all costs yourself unless you may have access to for Medicaid. Some people purchase long-term care insurance to cover costs after Medicare ends.
Can Part A cover care at home if I was never hospitalized?
Yes. Home health services covered by Part A do not require a prior hospital stay. Your doctor must order the services, you must be homebound, and the agency must be Medicare-certified. Many home health patients were recently hospitalized, but it is not a requirement.
Does Part A cover my doctor's bill when I am in the hospital?
No. Part A covers the hospital facility and its services. Your doctor's bill is covered by Part B. If you do not have Part B, you will receive a separate bill from the doctor and will owe it yourself.