Medicare Part A covers hospital stays, not outpatient care

Medicare Part A is the hospital insurance part of Medicare. It pays for inpatient hospital stays, skilled nursing facility care after a hospital stay, hospice care, and some home health services. It does not pay for doctor visits, outpatient procedures, prescription drugs, or routine care you receive without being admitted to the hospital.

Part A is automatic for most people at age 65. You do not have to do anything to get it if you are already receiving Social Security benefits — Medicare enrollment happens on its own. If you are not yet on Social Security, you will need to sign up for Medicare during your enrollment window, which is typically three months before, during, and three months after the month you turn 65.

Part A is funded through payroll taxes (the Medicare tax on your paychecks), so most people do not pay a monthly premium for it. However, you will pay out-of-pocket costs when you use hospital services: a deductible for each hospital stay, daily copayments if you stay longer than a certain number of days, and different cost-sharing amounts for skilled nursing facilities.

Key Takeaways

  • Part A covers inpatient hospital stays, skilled nursing care after hospitalization, hospice, and some home health services, but not outpatient doctor visits or procedures.
  • Part A is automatic at age 65 if you receive Social Security; otherwise you must sign up during your enrollment window.
  • Most people pay no monthly premium for Part A because it is funded by payroll taxes, but you will pay a deductible and copayments when you use hospital services.
  • To have coverage for doctor visits, outpatient care, and prescription drugs, you need Part B, Part D, and possibly Part C or a Medigap plan in addition to Part A.

What Part A actually covers in the hospital

When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, medications given in the hospital, lab tests, imaging, and other medically necessary services. The key word is inpatient — you must be formally admitted to a hospital bed, not treated in the emergency room or outpatient department and sent home the same day.

Part A also covers a skilled nursing facility (SNF) stay after you leave the hospital, but only if you were hospitalized for at least three consecutive days first and only if your doctor says you need skilled care — not just help with daily activities. The facility must be Medicare-approved. Part A pays for up to 100 days in a SNF per benefit period, though you will pay copayments after day 20.

Hospice care is covered by Part A when a doctor certifies that you have a terminal illness and have six months or less to live. Part A covers hospice services, medications related to your terminal condition, and equipment like oxygen or a hospital bed. Home health services are also covered by Part A in limited situations: you must be homebound, under a doctor's care, and need skilled nursing or therapy services.

What Part A does not cover

Part A does not pay for outpatient services — anything you receive without being admitted to the hospital. This includes doctor office visits, urgent care visits, emergency room visits that do not result in admission, X-rays or lab work done in an outpatient setting, and surgery performed in an outpatient facility. Even if you go to the hospital emergency room, if you are not admitted as an inpatient, Part A does not cover it.

Part A also does not cover prescription drugs, dental care, vision care, hearing aids, or routine physical exams. It does not cover long-term custodial care in a nursing home — only skilled nursing care after a hospital stay. If you need help with bathing, dressing, or meals but do not need skilled medical care, Part A will not pay for it.

Mental health services, rehabilitation services, and other specialty care are covered by Part A only if you are an inpatient in a hospital or approved facility. If you receive these services as an outpatient, you will need Part B coverage to help pay for them.

How much you pay out of pocket with Part A

Part A has a deductible for each benefit period. A benefit period begins the day you are admitted to a hospital and ends 60 days after you leave the hospital without being readmitted. If you are readmitted within 60 days, you are still in the same benefit period and do not owe another deductible. The deductible amount changes each year; you can find the current year's amount on Medicare.gov.

After you pay the deductible, Part A covers 100 percent of your hospital costs for days 1 through 60 of each hospital stay. On days 61 through 90, you pay a daily copayment. If you stay longer than 90 days, you have access to lifetime reserve days — 60 additional days that Medicare will cover during your lifetime, but you pay a higher daily copayment for those days. Once you use your lifetime reserve days, they are gone.

For skilled nursing facility care, you pay nothing for days 1 through 20. On days 21 through 100, you pay a daily copayment. After day 100 in a benefit period, Part A pays nothing and you are responsible for the full cost.

Why you need Part B, Part D, and possibly other coverage

Part A alone leaves major gaps in coverage. You will need Part B (medical insurance) to cover doctor visits, outpatient care, and preventive services. You will need Part D (prescription drug coverage) to help pay for medications you take at home. Many people also choose Part C (Medicare Advantage), which combines Parts A, B, and D into one plan offered by a private insurance company, or a Medigap policy, which is supplemental insurance that helps pay for the costs Part A and Part B do not cover.

Without Part B, you will pay the full cost of doctor visits out of pocket. Without Part D, you will pay the full cost of prescription drugs. Without supplemental coverage, you will pay the deductibles and copayments that Part A requires. Many seniors find that combining Part A with Part B, Part D, and either Part C or a Medigap plan gives them the coverage they need.

If you delay signing up for Part B or Part D when you first become may be able to access, you may face a permanent penalty on your premiums. The enrollment window for Part B and Part D is the same as for Part A: three months before, during, and three months after the month you turn 65.

When to contact your doctor or hospital

Before you are admitted to a hospital, ask your doctor whether the admission will be inpatient or outpatient. This matters because Part A only covers inpatient stays. If you are unsure of your status during your stay, ask the hospital staff directly — they should be able to tell you whether you are admitted as an inpatient or being treated as an outpatient.

If you receive a bill from a hospital or facility that you believe should have been covered by Part A, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or log into your Medicare account at Medicare.gov. You can also ask the hospital's billing department to explain the charges and why Part A did not cover them.

If you are approaching day 60 of a hospital stay and your doctor says you may need to stay longer, talk to the hospital social worker or discharge planner about your options. They can explain what your costs will be if you use lifetime reserve days and help you understand whether a skilled nursing facility or home health care might be a better option for your situation.

Frequently Asked Questions

Does Part A cover an emergency room visit?

Part A covers emergency room visits only if you are admitted to the hospital as an inpatient afterward. If you are treated in the emergency room and sent home, Part A does not cover it — you would need Part B to help pay for that visit. Always ask whether you are being admitted as an inpatient before you leave the emergency room.

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 Part A will cover during your entire lifetime, though you pay a higher daily copayment. Once those 60 days are used up, you are responsible for the full cost of the hospital stay. This is why many people choose supplemental coverage.

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

Most people do not pay a monthly premium for Part A because it is funded by payroll taxes. However, if you have not paid Medicare taxes for at least 40 quarters (10 years), you may have to pay a premium. You should still sign up for Part A at 65 even if you are working, unless you have health coverage through your employer that covers hospital care.

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

No. Part A covers skilled nursing facility care only after a hospital stay of at least three consecutive days. If you go directly to a nursing home from home, Part A will not cover it. You would need to pay out of pocket or have other coverage.

What is the difference between Part A and Part C?

Part A is traditional Medicare hospital insurance. Part C (Medicare Advantage) is a private insurance plan that includes Part A, Part B, and usually Part D all in one plan. With Part C, you still have Part A coverage, but you receive it through a private insurer instead of directly from Medicare, and you may have different copayments and coverage rules.