Does Medicare Part A Cover 100 Percent?

Medicare Part A is a foundational component of the Medicare program, serving as hospital insurance for eligible individuals. Many people believe this coverage eliminates all healthcare costs, leading to a common question about whether it provides 100 percent coverage. This perception is not entirely accurate, as Medicare Part A involves cost-sharing elements. This article clarifies Medicare Part A coverage and associated out-of-pocket expenses.

Services Covered by Medicare Part A

Medicare Part A primarily covers inpatient care received in hospitals. This includes semi-private rooms, meals, general nursing services, and medications administered during inpatient treatment. It extends to acute care hospitals, critical access hospitals, and inpatient rehabilitation facilities.

The coverage also encompasses skilled nursing facility (SNF) care, provided after a qualifying inpatient hospital stay. This includes room and board and medical services. Additionally, Medicare Part A covers hospice care for individuals with a terminal illness, for comfort and support. Some home health care services, specifically intermittent skilled nursing care and certain therapy services for those who are homebound, are also included.

Out-of-Pocket Costs with Medicare Part A

Medicare Part A does not provide 100 percent coverage; beneficiaries are responsible for out-of-pocket expenses. These costs can include deductibles, coinsurance, and in some cases, monthly premiums. Understanding these financial obligations is essential.

A Part A deductible applies to each benefit period for inpatient hospital stays. In 2025, this deductible is $1,676. After the deductible is met, Medicare generally covers the approved costs for the first 60 days of an inpatient hospital stay within that benefit period.

Coinsurance applies for hospital stays extending beyond 60 days. For days 61 through 90 of a hospitalization in a benefit period, the daily coinsurance is $419 in 2025. Beyond day 90, individuals can use up to 60 “lifetime reserve days,” which incur a daily coinsurance of $838 in 2025. Once these lifetime reserve days are exhausted, the beneficiary is responsible for all hospital costs.

For skilled nursing facility stays, coinsurance also applies. The first 20 days of care within a benefit period are covered at $0. However, for days 21 through 100, the daily coinsurance amount is $209.50 in 2025. After 100 days in a skilled nursing facility, the beneficiary is responsible for all costs.

Most individuals do not pay a monthly premium for Medicare Part A. This applies to those who have worked and paid Medicare taxes for at least 40 quarters (about 10 years). However, if an individual has paid Medicare taxes for fewer than 40 quarters, they may be required to pay a monthly premium. In 2025, those with 30-39 quarters of coverage pay $285 monthly, while those with fewer than 30 quarters pay $518 per month.

Benefit Periods and Cost Sharing

A “benefit period” is fundamental to understanding how Medicare Part A costs apply. A benefit period begins the day a beneficiary is admitted as an inpatient to a hospital or skilled nursing facility. It ends when the beneficiary has been out of a hospital or skilled nursing facility for 60 consecutive days.

The Part A deductible applies per benefit period, not annually. For example, if a patient is hospitalized, discharged, and then readmitted after 60 days have passed, a new benefit period begins, and a new deductible would apply. This means an individual could pay the deductible multiple times within a single calendar year if their hospital stays are separated by more than 60 days.

Within a single benefit period, coinsurance for extended hospital or skilled nursing facility stays is calculated. Once the deductible is met, there are no coinsurance costs for the first 60 days of an inpatient hospital stay. Coinsurance then begins for days 61-90, followed by the use of lifetime reserve days for stays beyond 90 days. This system ties financial responsibility to the duration of inpatient services within each distinct period of illness or recovery.

Services Not Covered by Medicare Part A

Medicare Part A focuses on inpatient and specific post-hospital care but does not cover all healthcare services. Certain services are excluded, which is why Part A alone does not provide comprehensive coverage. These exclusions highlight the importance of understanding the full scope of Medicare benefits.

Long-term custodial care, such as assistance with daily activities in nursing homes or at home, is not covered. While it covers medically necessary skilled nursing facility care, it does not pay for room and board if the care is primarily custodial. Private duty nursing, which involves individualized nursing care, is also not included.

Personal care items, such as razors or slippers, that are not medically necessary are excluded from Part A coverage. Most outpatient prescription drugs are not covered under Part A; these are addressed by Medicare Part D. Routine vision, dental, and hearing care, including eye exams, dental cleanings, and hearing aids, are not covered. Elective procedures not considered medically necessary are excluded from coverage by Medicare Part A.