Medicare Part A is the hospital insurance half of Original Medicare. Most people pay no premium for it, which can make it easy to overlook — but understanding what Part A actually covers, what it doesn’t, and what you’ll owe out of pocket matters when you’re actually hospitalized or need skilled nursing care.
What Medicare Part A covers
Inpatient hospital care
Part A pays for inpatient hospital stays — meaning you have been formally admitted. This includes a semi-private room, meals, general nursing care, and most hospital services and supplies during your stay. Physician services during a hospital stay are billed separately under Part B, not Part A.
An important distinction: being kept ‘under observation’ in a hospital is not the same as being admitted. Observation status is billed under Part B, and time spent under observation does not count toward the three-day inpatient hospital stay required to qualify for covered skilled nursing facility care.
Skilled nursing facility (SNF) care
After a qualifying hospital inpatient stay of at least 3 consecutive days, Part A covers skilled nursing facility care. “Skilled” means care requiring licensed nurses or therapists — wound care, IV medications, physical therapy, occupational therapy.
Coverage is limited:
- Days 1–20: Medicare pays 100% (after the Part A deductible is met for the benefit period)
- Days 21–100: You pay a daily coinsurance ($209.50/day in 2025). Medicare pays the rest.
- Day 101+: Medicare pays nothing. You pay the full daily rate.
Medicare does not cover custodial skilled nursing care — help with bathing, dressing, or eating — when that’s the only care needed. Coverage ends when you no longer need skilled care, even if you still need help with daily activities.
Home health care
Part A (or Part B, depending on circumstances) covers medically necessary home health services when you’re homebound and need skilled nursing care or therapy. Covered services include skilled nursing visits, physical therapy, speech therapy, and occupational therapy. Home health aides may be covered as part of a home health plan, but only when skilled care is also being provided.
Medicare does not cover 24-hour home care, meals delivered to your home, or homemaker services.
Hospice care
Part A covers hospice care for people with a terminal illness who are expected to live 6 months or less if the illness runs its normal course, and who choose comfort-focused care rather than curative treatment. Medicare covers most hospice services with minimal cost-sharing: a copay for outpatient drugs for pain and symptom management, and a small daily copay for inpatient respite care. Hospice care can be provided at home, in a hospice facility, or in a nursing home.
What Part A costs
Premiums
Most people pay no premium for Part A if they or their spouse worked and paid Medicare taxes for at least 40 quarters (10 years). This premium-free status is why most people don’t think much about Part A.
If you have 30–39 quarters of work history, you pay a reduced premium ($284/month in 2025). With fewer than 30 quarters, you pay the full premium ($518/month in 2025). These are relatively rare situations.
Deductible
Part A has a per-benefit-period deductible, not an annual deductible. In 2025, the deductible is $1,676. A benefit period begins when you are admitted to a hospital or SNF and ends when you have been out of a hospital or SNF for 60 consecutive days.
This means if you are hospitalized twice in the same year but your stays are separated by less than 60 days, you may owe the deductible only once. If the stays are separated by more than 60 days, you owe the deductible again for the second benefit period. There is no cap on how many benefit periods you can have in a year.
Coinsurance for long hospital stays
For most hospital stays, the Part A deductible is the main cost. But for extended stays:
- Days 1–60: You pay only the deductible
- Days 61–90: You pay $419/day coinsurance (2025)
- Days 91–150: You pay $838/day (“lifetime reserve days” — you get 60 of these total in your lifetime)
- Beyond 150 days: Medicare pays nothing
🆓 Questions about what Part A covers for your situation?
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When Part A coverage starts
If you are eligible for premium-free Part A and you’re already collecting Social Security when you turn 65, you are enrolled in Part A automatically, effective the first day of the month you turn 65. If you’re not yet collecting Social Security, you must actively enroll during your Initial Enrollment Period (3 months before to 3 months after your 65th birthday).
Delaying Part A when you’re eligible for it premium-free is rarely beneficial — unlike Part B, there’s no scenario where most people would want to skip premium-free Part A. The main reason to delay is if you have an HSA and want to keep contributing (enrolling in Part A ends HSA contribution eligibility).
Does Medigap cover Part A gaps?
Yes — this is one of Medigap’s primary functions. Medigap Plan G, the most popular option for new enrollees, covers the Part A deductible, coinsurance for days 61–150, hospital costs beyond Medicare’s coverage, and hospice care coinsurance. This turns the Part A benefit period deductible risk into a more predictable annual expense.
Medicare Advantage plans also cover Part A services but apply their own cost-sharing rules, which vary by plan.
Bottom line
Part A is the foundation of Medicare hospital coverage. For most people it’s premium-free, but “free” doesn’t mean cost-free — the per-benefit-period deductible and daily coinsurance for extended stays can be significant. The skilled nursing benefit is valuable but limited: 100 days maximum, skilled care only, and the 3-day hospital stay requirement applies. Understanding these rules before you need hospital care is the best preparation.
🆓 Want to make sure you have the right coverage alongside Part A?
Our partner Chapter Medicare can review your situation and help you decide whether Medigap, Medicare Advantage, or another option best fills the gaps Part A leaves.
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Disclosure: We may receive a referral from Chapter if you choose to use their service. Chapter is a licensed health insurance agency and is not affiliated with or endorsed by Medicare or any government agency.
Further Reading
- Medicare Parts A, B, C, and D Explained
- Medicare Costs and Premiums
- Medigap / Medicare Supplement Insurance Explained
- Medicare Advantage vs. Original Medicare
- Medicare and HSAs
- How to Plan for Long-Term Care Costs
This article is for general educational purposes only and does not constitute insurance or financial advice. Visit medicare.gov or contact 1-800-MEDICARE, or consult a licensed advisor for guidance specific to your situation.