Medicare Part A, often called hospital insurance, forms the foundation of Medicare coverage by protecting beneficiaries from the high costs of inpatient hospital care, skilled nursing facility stays, hospice care, and some home health services. Understanding Part A is essential for anyone approaching Medicare eligibility or planning for healthcare costs in retirement.

What Medicare Part A Covers

Part A provides comprehensive coverage for several critical healthcare services. Inpatient hospital care includes semi-private rooms, meals, general nursing services, medications administered during your stay, and other hospital services and supplies. This coverage extends to care in critical access hospitals and inpatient mental health care, with certain limitations.

Skilled nursing facility care is covered when you need rehabilitation or skilled nursing services following a qualifying hospital stay of at least three consecutive days. Medicare covers up to 100 days per benefit period in a skilled nursing facility, but only when you require daily skilled care that meets Medicare's strict definition. Custodial or long-term care is not covered.

Hospice care provides compassionate end-of-life care for terminally ill patients with a life expectancy of six months or less if the illness runs its normal course. Coverage includes nursing care, medications for symptom control and pain relief, medical equipment, counseling, and short-term respite care to give family caregivers a break.

Home health care is covered when you're homebound and require intermittent skilled nursing care, physical therapy, or speech-language pathology services under a doctor's care plan. This can include part-time skilled nursing, physical therapy, occupational therapy, speech-language pathology, and medical social services.

2025 Part A Costs and Deductibles

The majority of Medicare beneficiaries—approximately 99%—receive Part A premium-free because they or their spouse paid Medicare taxes for at least 40 quarters (10 years) during their working years. This is one of Medicare's most valuable benefits, as hospital care ranks among the most expensive healthcare services.

For 2025, the Part A inpatient hospital deductible is $1,676 per benefit period, representing a $44 increase from the 2024 deductible of $1,632. This deductible covers the first 60 days of each hospital stay within a benefit period. After that, coinsurance kicks in: $419 per day for days 61-90 of hospitalization (up from $408 in 2024), and $838 per day for lifetime reserve days beyond 90 days (up from $816 in 2024).

For skilled nursing facility care, Part A covers the first 20 days at no cost to you after you've met your Part A deductible. Days 21-100 require coinsurance of $209.50 per day in 2025. After 100 days, you're responsible for all costs.

Individuals who don't qualify for premium-free Part A can purchase coverage. In 2025, those with 30-39 quarters of coverage pay a reduced premium of $285 monthly, while those with fewer than 30 quarters pay the full premium of $518 monthly.

Understanding Benefit Periods

Medicare measures your use of hospital and skilled nursing facility services in benefit periods rather than calendar years. A benefit period begins the day you're admitted as an inpatient and ends when you haven't received inpatient hospital or skilled nursing facility care for 60 consecutive days. If you're readmitted after one benefit period ends, a new benefit period begins, and you'll pay the inpatient hospital deductible again.

This system means you could have multiple benefit periods in a single year, each requiring a new deductible. Conversely, if you have several hospital stays close together, they might fall within the same benefit period, requiring only one deductible. Understanding benefit periods is crucial for predicting your out-of-pocket costs.

Lifetime reserve days provide additional coverage beyond the standard 90 days per benefit period. You have 60 lifetime reserve days that can be used when you're hospitalized for more than 90 days in a benefit period. Once used, these reserve days are not renewed—you only get 60 for your entire lifetime on Medicare.

What Part A Doesn't Cover

Despite its comprehensive hospital coverage, Part A has significant gaps. Private-duty nursing, television and phone in your room, personal care items like razors and slipper socks, and private rooms (unless medically necessary) aren't covered. These limitations mean additional out-of-pocket costs during hospital stays.

Part A doesn't cover long-term custodial care, which represents the largest coverage gap for many seniors. If you need help with activities of daily living like bathing, dressing, or eating but don't require skilled nursing or rehabilitation services, Medicare Part A won't pay. Long-term care insurance or private payment becomes necessary for extended custodial care.

Outpatient prescription drugs aren't covered under Part A, even if you're hospitalized. You'll need Part D or Medicare Advantage coverage for most prescription medications. Additionally, dental care, vision care, and hearing aids fall outside Part A's scope.

Premium-Free Part A Eligibility

Most people automatically qualify for premium-free Part A through their own or their spouse's work history. You're eligible if you or your spouse worked and paid Medicare taxes for at least 40 quarters (10 years). This includes most people who worked full-time for at least 10 years in jobs where Medicare taxes were withheld.

Individuals receiving Social Security or Railroad Retirement Board benefits are automatically enrolled in Part A (and Part B) when they turn 65, with their Medicare card arriving in the mail about three months before their birthday. If you're not receiving these benefits, you need to actively enroll in Medicare during your Initial Enrollment Period.

Some individuals qualify for premium-free Part A through their spouse's work record, including current spouses, divorced spouses (if married at least 10 years), and widows or widowers. If you don't qualify for premium-free Part A through work history, you can purchase coverage, though the premiums can be substantial.

Maximizing Your Part A Benefits

To get the most from Part A, understand that it works best with supplemental coverage. Original Medicare beneficiaries often purchase Medigap policies to cover Part A's cost-sharing requirements, including deductibles and coinsurance. Medicare Advantage plans also include Part A coverage and often feature out-of-pocket maximums that limit your annual spending.

Always verify that facilities accept Medicare before receiving services. While most hospitals participate in Medicare, not all skilled nursing facilities do. Ask about Medicare certification and whether your specific situation meets Medicare's coverage criteria, especially for skilled nursing and home health services.

Keep detailed records of your hospital admissions, discharges, and benefit periods. Understanding when benefit periods start and end helps you anticipate when new deductibles will apply. This knowledge proves especially valuable if you have multiple health issues requiring frequent hospitalization.