Medicare Part A, often called hospital insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people qualify for it premium-free at age 65 if they or a spouse paid Medicare taxes for at least 10 years (40 quarters) of work. Here’s what it actually pays for, what it costs you, and where the gaps are.
Inpatient Hospital Stays
This is the core of Part A. When you’re admitted to a hospital as an inpatient, Part A covers your semi-private room, meals, general nursing care, medications administered during your stay, and other hospital services tied to your treatment. It does not cover private rooms (unless medically necessary), private-duty nursing, personal care items like razors, or separate charges for a television or phone in your room.
The key word here is “inpatient.” If you’re at the hospital under observation status, even overnight, that doesn’t count as an inpatient admission. This distinction matters more than most people realize, especially when it comes to qualifying for skilled nursing care afterward.
What You’ll Pay for a Hospital Stay
Part A uses a system called benefit periods rather than annual limits. A benefit period starts the day you’re admitted as an inpatient and ends once you’ve been out of a hospital or skilled nursing facility for 60 consecutive days. Each new benefit period resets your costs, but it also resets your deductible.
For 2025, the numbers break down like this:
- Days 1 through 60: You pay a $1,676 deductible for the entire benefit period, then $0 per day.
- Days 61 through 90: You pay $419 per day on top of the deductible.
- Days 91 and beyond: You pay $838 per day, drawing from a pool of 60 “lifetime reserve days.” Once those 60 days are used up over the course of your life, they don’t come back.
For 2026, those costs rise: the deductible goes up to $1,736, the daily coinsurance for days 61 through 90 becomes $434, and lifetime reserve days cost $868 each. If you have a long or complicated hospitalization, the out-of-pocket exposure adds up quickly, which is one reason many people carry supplemental (Medigap) coverage.
Skilled Nursing Facility Care
Part A covers care in a skilled nursing facility, but only under specific conditions. You must first have a qualifying inpatient hospital stay of at least three consecutive days (not counting the discharge day). Time spent in the emergency room or under observation before admission doesn’t count toward those three days. You then need to enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital.
Your doctor must determine that you need daily skilled care, such as intravenous medications, wound care, or physical therapy, and that care must be related to a condition treated during your hospital stay or a new condition that developed while you were receiving skilled nursing services. Simply needing help with daily activities like bathing or eating (custodial care) does not qualify.
For the first 20 days in a skilled nursing facility, Part A covers the full cost after your deductible. Days 21 through 100 require a daily coinsurance payment. After day 100, Part A stops covering skilled nursing entirely for that benefit period.
Hospice Care
Part A covers hospice care for people with a terminal illness when a doctor certifies a life expectancy of six months or less. Hospice shifts the focus from curing a disease to managing pain, symptoms, and quality of life. The benefit is broad: it covers nursing care, medications for pain and symptom control, medical equipment, and emotional and spiritual support for both you and your family, including grief counseling.
Once you elect hospice, your hospice team arranges all care related to your terminal diagnosis. You pay a copayment of up to $5 per prescription for outpatient drugs used for pain and symptom management. Nearly everything else related to the terminal illness is covered at no cost. You still keep your regular Medicare coverage for any conditions unrelated to the terminal diagnosis.
Home Health Services
Part A helps cover home health care if you meet three requirements: you’re homebound, you need skilled nursing care or therapy on a part-time or intermittent basis, and a doctor orders the care. “Homebound” means leaving your home is a major effort because of illness or injury, requiring help from another person or assistive devices like a wheelchair, walker, or crutches.
“Part-time or intermittent” generally means up to 8 hours per day of combined skilled nursing and home health aide services, with a maximum of 28 hours per week. In some cases, your provider can authorize up to 35 hours per week for a short period. If you need more than part-time skilled care, you won’t qualify for this benefit.
Home health services can include skilled nursing, physical therapy, occupational therapy, speech therapy, and medical social services. There’s no deductible or coinsurance for home health visits covered under Part A.
Blood Coverage
Part A covers blood you receive as a hospital inpatient, with one catch. If the hospital has to purchase blood for you, you’re responsible for the cost of the first three units (pints) per calendar year. You can avoid that cost if someone donates blood on your behalf or if the hospital obtains it from a blood bank at no charge.
Who Pays a Premium and Who Doesn’t
Most people pay nothing for Part A because they or a spouse accumulated enough work credits through Medicare payroll taxes. If you don’t have enough credits, you can still buy into Part A, but you’ll pay a monthly premium and must also enroll in Part B. If you delay enrollment past your initial eligibility window, a late-enrollment penalty can increase your premium by up to 10%, and you’ll pay that higher amount for twice the number of years you could have been enrolled but weren’t.
What Part A Does Not Cover
Part A has significant gaps. Long-term custodial care, the kind of ongoing help with daily activities that many people need as they age, is not covered. If you need a nursing home primarily for help with bathing, dressing, and eating rather than for skilled medical care, Medicare won’t pay for it.
Other exclusions across Original Medicare (Parts A and B combined) include most dental care, routine eye exams for glasses, hearing aids, cosmetic surgery, and massage therapy. Part A specifically won’t cover private-duty nursing during a hospital stay, personal convenience items, or care from a provider who has opted out of Medicare (except in emergencies). These gaps are important to plan around, especially if you’re deciding between Original Medicare and a Medicare Advantage plan or evaluating Medigap policies.