Medicare Part A is hospital insurance, not doctor visits
Medicare Part A covers inpatient hospital stays, skilled nursing care after hospitalization, hospice care, and some home health services. It does not cover doctor office visits, outpatient procedures, or prescription drugs — those fall under Part B, Part D, and other Medicare categories. Part A is the automatic piece: most people who worked and paid Medicare taxes for at least 10 years receive it at no monthly premium when they turn 65.
The program works by paying the hospital or facility directly, not you. You pay a deductible when you enter the hospital (currently $1,676 per benefit period, though this amount changes yearly), and then Medicare covers the full cost of your stay for the first 60 days. After that, you pay a daily copay if you stay longer. The key word is inpatient — you must be formally admitted to the hospital, not just treated in the emergency room or observation unit.
Key Takeaways
- Part A covers hospital stays, skilled nursing facilities, hospice, and some home health care, but not doctor visits or prescription drugs.
- You pay one deductible per benefit period (currently $1,676), and Medicare covers the full cost of your hospital stay for the first 60 days.
- After 60 days in the hospital, you pay a daily copay; after 90 days, the copay increases and you begin using lifetime reserve days.
- Skilled nursing care is covered only if you were hospitalized for at least three days first and are admitted within 30 days of discharge.
- Most people receive Part A automatically at 65 if they worked and paid Medicare taxes for at least 10 years; no process is required.
What Part A actually pays for during a hospital stay
When you are admitted to a hospital as an inpatient, Part A covers your room, meals, nursing care, lab tests, imaging, and medications given to you in the hospital. It also covers blood transfusions, operating room time, and anesthesia. You do not receive a bill for these services — Medicare pays the hospital directly.
The catch is the definition of "inpatient." If you are in the hospital but not formally admitted — for example, you spend the night in the emergency department or in observation — Part A does not cover it. Observation stays are often covered under Part B instead, which means you pay 20 percent of the cost after your Part B deductible. This distinction matters because many people think they were admitted when they were actually in observation, and they receive an unexpected bill.
Skilled nursing facility coverage after hospitalization
Part A covers a skilled nursing facility (a nursing home with medical staff on site) only if you meet two conditions: you were hospitalized for at least three consecutive days, and you are admitted to the facility within 30 days of leaving the hospital. The stay must be for the same condition you were hospitalized for, or a related one.
Part A covers the first 20 days at no cost to you. From day 21 to day 100, you pay a daily copay (currently $209.50 per day, adjusted yearly). After 100 days in a benefit period, you pay the full cost yourself. Many people do not know this limit exists and assume nursing home care is covered indefinitely.
Hospice and home health services under Part A
Part A covers hospice care when a doctor certifies that you have six months or less to live. You pay nothing for hospice services themselves, though you may pay a small copay for drugs and respite care (temporary care that gives your family a break). Hospice is covered regardless of how long you actually live — the six-month estimate is a medical judgment, not a may provide.
Home health services are also covered under Part A when you are homebound and need skilled care — such as physical therapy, nursing visits, or wound care — ordered by your doctor. Unlike skilled nursing, home health has no daily limit and no copay; Medicare covers the full cost. However, you must be homebound (leaving home requires considerable effort), and the care must be skilled, not just help with daily tasks like bathing or cooking.
How the deductible and copay structure works
Part A uses a benefit period instead of a calendar year. A benefit period starts the day you enter the hospital and ends 60 days after you leave. If you are readmitted within those 60 days, you are still in the same benefit period and do not pay a new deductible. If you are readmitted after 60 days have passed, a new benefit period begins and you pay a new deductible.
For the first 60 days of hospitalization, you pay the deductible (currently $1,676) and Medicare covers everything else. Days 61 through 90, you pay a daily copay (currently $419 per day). If you stay longer than 90 days, you enter your lifetime reserve days — 60 additional days that Medicare will cover during your lifetime, but at a higher copay (currently $838 per day). Once you use your lifetime reserve days, Medicare stops paying and you pay the full hospital bill.
Who gets Part A and when it starts
You receive Part A automatically when you turn 65 if you are a U.S. citizen or permanent resident and have lived in the country for at least five years. You do not need to explore. However, you must have worked and paid Medicare taxes for at least 10 years (40 quarters) to receive Part A with no premium. If you have fewer than 10 years of work history, you can still buy Part A, but you will pay a monthly premium.
If you are under 65, you may receive Part A if you have been on Social Security disability for at least 24 months, or if you have end-stage renal disease or ALS. Otherwise, you cannot enroll in Part A until you turn 65, even if you retire early.
Part A does not cover everything in the hospital
Part A covers the hospital facility and its services, but it does not cover the doctor who treats you. Your doctor's bill is covered under Part B, and you pay 20 percent of it after your Part B deductible. This is a common surprise: people assume the hospital bill covers everything, then receive a separate bill from their surgeon or cardiologist.
Part A also does not cover private duty nursing, a private room (unless medically necessary), or a television and telephone in your room — you pay for those extras yourself. Prescription drugs you take at home after discharge are covered under Part D, not Part A. Rehabilitation in an outpatient setting is covered under Part B.
Frequently Asked Questions
Do I have to pay for Part A?
No monthly premium if you worked and paid Medicare taxes for at least 10 years. You pay a deductible ($1,676 per benefit period) and copays only when you use hospital or skilled nursing services. If you have fewer than 10 years of work history, you can buy Part A, but the monthly premium is around $278 to $505 depending on your work record.
What is the difference between Part A and Part B?
Part A covers hospital stays, skilled nursing, hospice, and home health. Part B covers doctor visits, outpatient procedures, lab work, imaging, and medical equipment. Most people need both to have full coverage. Part B does have a monthly premium (currently $164.90 for most people) and a yearly deductible.
If I am in the hospital for observation, does Part A cover it?
No. Observation stays are covered under Part B, and you pay 20 percent of the cost after your Part B deductible. Ask the hospital whether you are being admitted as an inpatient or placed in observation — the difference affects what you pay. If you disagree with the hospital's decision, you can file an appeal.
Can I use my lifetime reserve days and get them back?
No. Lifetime reserve days are a one-time benefit of 60 additional days. Once you use them, they are gone for the rest of your life. After you exhaust them, Medicare stops paying for hospital stays and you pay the full cost yourself.
Does Part A cover nursing home care forever?
No. Part A covers up to 100 days per benefit period in a skilled nursing facility, and only if you were hospitalized for at least three days first. After 100 days, you pay the full cost. Long-term custodial care (help with daily living, not skilled medical care) is not covered by Medicare at all.