Medicare Part A — hospital coverage and what it actually pays for
Reviewed by the How To Help Your Elders Team | Updated March 2026
Medicare Part A covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, home health services, and hospice. Most people pay no monthly premium for Part A, but there are deductibles and daily copays that add up fast during longer stays. The 2025 Part A deductible is $1,676 per benefit period.
Part A Sounds Simple Until You See the Bills
The first time my father went to the hospital after turning 65, I thought Medicare Part A would just handle it. He had a fall, broke his hip, needed surgery, spent five days in the hospital followed by two weeks in a skilled nursing facility. I assumed Medicare covered all of it and didn't pay much attention to the bills. Then the bills started coming, and I realized I had no idea what Medicare Part A actually paid for or what my father's actual out-of-pocket costs would be.
When you're managing your parent's healthcare, Part A feels like it should be the straightforward one. Hospital coverage sounds simple enough. In reality, Part A is surprisingly specific about what it covers and what the costs are. The good news is that Part A usually doesn't have a monthly premium because your parent paid for it over their working years. According to CMS, about 99 percent of Medicare beneficiaries qualify for premium-free Part A based on their work history or their spouse's work history. The catch is understanding when it pays, how much it pays, and what your parent has to pay instead.
This matters because hospital bills are huge. A single night in the hospital can cost thousands of dollars before insurance. A week of skilled nursing facility care can run into tens of thousands. If you understand Part A before your parent needs it, you won't be shocked when the bills come, and you can actually plan around it.
What Part A Actually Covers
Medicare Part A covers three main categories: inpatient hospital stays, skilled nursing facility care, and home health services. It also covers hospice, which works differently enough to deserve its own section.
Inpatient hospital means your parent is formally admitted to the hospital and stays overnight. Part A covers this after your parent pays the deductible. According to CMS, the Part A deductible for 2025 is $1,676 per benefit period. Once it's paid, Medicare covers the hospital stay for the first 60 days.
Skilled nursing facility, or SNF, is not the same as a regular nursing home. This is important. A skilled nursing facility is where your parent goes for medical care: physical therapy after hip surgery, wound care after an infection, medication management after a stroke. Medicare only covers SNF care if it follows a qualifying hospital stay. Your parent has to be admitted to the hospital, stay at least three consecutive days as an inpatient, and then be transferred to a skilled nursing facility. They can't just walk into a nursing home and expect Medicare to pay.
Home health services means a nurse or therapist comes to your parent's home to provide medical care. Part A covers this if your parent is homebound and being treated by a doctor for a medical condition. It might be skilled nursing, physical therapy, occupational therapy, or speech therapy. It's not covered if your parent just needs help around the house with cleaning or personal care. It has to be medical.
Hospice is covered by Part A when life expectancy is six months or less as certified by a doctor. Hospice coverage is remarkably comprehensive, covering medications, equipment, counseling, and respite care. According to Medicare.gov, hospice benefits include physician services, nursing care, medical equipment, medical supplies, drugs for symptom control, aide and homemaker services, grief counseling, and short-term respite care. This is actually one of Medicare's most generous benefits, and it's severely underused because people don't understand what it covers.
Hospital Coverage: The Numbers That Matter
Your parent's hospital costs under Part A depend on how long they stay. The cost structure is tiered, and each tier is significantly more expensive than the last.
For the first 60 days in the hospital, after paying the deductible, Medicare covers all the costs. Your parent doesn't pay anything else. This includes the hospital room, meals, tests, medications given in the hospital, and supplies.
Days 61 through 90 are different. Medicare still covers most of it, but your parent now pays a daily copay. According to CMS, the daily copay for days 61 through 90 in 2025 is $419 per day. If your parent is in the hospital for 75 days, they're paying that copay for 15 of those days. That's $6,285 out of pocket on top of the initial deductible.
Beyond 90 days, Medicare gets even more restrictive. Your parent has lifetime reserve days, 60 of them total, and they never reset. Once they use those 60 reserve days over their entire lifetime, Medicare stops paying and your parent pays everything. According to CMS, the coinsurance for lifetime reserve days in 2025 is $838 per day. Most people never hit this limit. But if your parent has a serious, ongoing condition that requires extended hospitalization, it's a real consideration.
This is why people get surprised. They think the hospital is "covered" by Medicare and don't realize they're paying a daily copay for stays over 60 days. They don't plan for it. Then a week past day 60, they get a bill for thousands of dollars.
Skilled Nursing: Not What Most People Think
Skilled nursing facility care is where the most confusion happens. People hear "nursing home" and think Medicare covers nursing home care. It doesn't, unless the nursing home is specifically functioning as a skilled nursing facility and the stay follows a qualifying hospital stay.
Your parent can't just go into a nursing home and have Medicare pay. They have to come out of a hospital first. They have to have been admitted to that hospital as an inpatient, not just under observation status. Some ER visits or brief hospital stays under "observation" don't count as inpatient admissions, even if your parent spent the night. It has to be a formal admission, and the stay must be at least three consecutive days. CMS has specific guidelines on what constitutes an inpatient admission versus observation status, and this distinction catches many families off guard.
Then the skilled nursing has to be for something medical that the hospital is referring them for. Usually it's physical therapy after surgery, wound care, or IV medications. It's therapy or medical management, not just living assistance.
Once your parent is in the skilled nursing facility on a Part A-covered stay, coverage lasts up to 100 days. But it's not free for all 100 days.
The first 20 days are covered at 100 percent. Your parent doesn't pay a separate deductible because they already paid the Part A deductible for the hospital stay.
Days 21 through 100 require a daily copay. According to CMS, the daily copay for skilled nursing facility days 21 through 100 in 2025 is $209.50 per day. If your parent is in the skilled nursing facility for 60 days, they're paying that copay for 40 of those days. That's $8,380 out of pocket.
After 100 days, Medicare stops paying. If your parent still needs facility care, they're paying everything themselves or relying on Medicaid or private long-term care insurance.
This is important to understand because people come out of the hospital thinking "Medicare is covering my recovery" and don't realize they're accumulating bills in the skilled nursing facility.
The Hospice Benefit: Medicare's Most Generous Coverage
Hospice is different from hospital and skilled nursing. It's not about fighting the illness. It's about comfort and quality of life when someone has a terminal diagnosis.
When your parent is enrolled in hospice, Medicare Part A covers almost everything. Medications for comfort, equipment like hospital beds or oxygen, nursing care, doctor visits, therapist visits, chaplain visits, grief counseling for the family, and respite care so caregivers can get a break. The only thing your parent typically pays is a copay for medications, usually five dollars or less per prescription.
The eligibility requirement is that a doctor certifies your parent has six months or less to live. This can be renewed if they continue to meet that criteria. Some people are on hospice for longer than six months. According to the National Hospice and Palliative Care Organization, the median length of hospice service is about 18 days, but many patients benefit from enrolling earlier when there's more time for the support and comfort measures to make a real difference.
What makes hospice underused is partly lack of awareness and partly misunderstanding about what it means. Choosing hospice doesn't mean giving up. It means choosing comfort care instead of aggressive treatment. If your parent has a terminal diagnosis, asking their doctor about hospice coverage under Part A is worth doing. It's one of Medicare's best benefits.
What This Means for Your Planning
Understanding Part A means understanding that hospital and skilled nursing facility care is expensive even with Medicare. Your parent needs to know they might pay substantial out-of-pocket costs if they have a long hospital stay or an extended stay in a skilled nursing facility.
This is one reason people buy Medigap insurance. A Medigap policy can cover the Part A deductible and the daily copays in the hospital and skilled nursing facility. Many people find this worthwhile, especially if they have chronic conditions that might lead to hospitalization.
It's also why understanding Part A early is helpful. Before your parent needs a hospital stay, you can have a conversation about what they want if they're seriously ill, whether hospice makes sense for their values, and what financial resources they have to handle out-of-pocket costs. You're having these conversations before a crisis, not during one.
Your parent paid into Medicare taxes for decades. Part A is waiting for them. It covers the major pieces. But the copays and deductibles are real, and they add up. Knowing that before something happens means you're actually prepared instead of shocked.
Frequently Asked Questions
Does Part A have a monthly premium?
For most people, no. About 99 percent of Medicare beneficiaries qualify for premium-free Part A based on their work history (or their spouse's). People who didn't work long enough paying Medicare taxes can still buy Part A, but the monthly premium can be up to $518 per month in 2025.
What is the Part A deductible, and how often does it reset?
The Part A deductible is $1,676 in 2025. It resets per benefit period, not per calendar year. A benefit period starts when your parent is admitted to the hospital and ends when they've been out of the hospital or skilled nursing facility for 60 consecutive days. If they're readmitted after the benefit period ends, they pay the deductible again.
What's the difference between "inpatient" and "observation" status?
Inpatient status means your parent has been formally admitted to the hospital. Observation status means they're being monitored but haven't been admitted. This distinction matters because skilled nursing facility coverage requires a qualifying inpatient stay of at least three days. Observation days do not count. Always ask the hospital whether your parent has been admitted or is under observation.
Does Part A cover nursing home care?
Only under specific conditions. Part A covers skilled nursing facility care for up to 100 days, but only after a qualifying inpatient hospital stay of at least three days, and only for skilled medical care like physical therapy or wound care. Part A does not cover long-term custodial care in a nursing home for activities of daily living.
What does hospice actually cover?
Hospice under Part A covers doctor services, nursing care, medications for comfort, medical equipment, supplies, aide services, physical and occupational therapy, speech therapy, social worker services, grief counseling for the family, and short-term respite care. The only cost to your parent is typically a small copay for medications (usually five dollars or less per prescription).
Should my parent get Medigap insurance to cover Part A costs?
If your parent has chronic conditions or health situations that make hospitalization likely, Medigap is worth considering. Medigap policies can cover the Part A deductible and daily copays, significantly reducing out-of-pocket costs during hospital and skilled nursing stays. The best time to buy Medigap is during the six-month window after enrolling in Part B, when insurers cannot deny coverage or charge more based on health status.