What is covered by Medicare Part A?

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Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and limited home health services.

🏥 Inpatient Hospital Care

  • Semi-private rooms and meals
  • General nursing and specialized care (like ICU)
  • Drugs, supplies, and tests given during a stay
  • Inpatient rehabilitation and surgeries

🏨 Skilled Nursing Facility (SNF) Care

  • Short-term care after a 3-day inpatient hospital stay
  • Semi-private rooms and meals
  • Rehabilitation therapies (physical, speech, occupational)
  • Medical supplies and skilled nursing care

🕊️ Hospice Care

  • Palliative medications for pain and symptom relief
  • Medical equipment and nursing services
  • Grief and loss counseling for family
  • Respite care to give regular caregivers a break

🏡 Home Health Services

  • Intermittent skilled nursing care
  • Physical, occupational, or speech therapy
  • Part-time medical social services
  • Must be certified homebound by a doctor

Does Medicare cover 100% of part A?

No, Medicare Part A does not cover 100% of your hospital and inpatient costs.

While most people do not pay a monthly premium for Medicare Part A because they worked and paid taxes long enough, you still have out-of-pocket costs like deductibles and daily coinsurance.

Out-of-Pocket Costs for Part A

  • Deductible: You must pay a Part A deductible of $1,736 per benefit period before Medicare starts paying for inpatient hospital care.
  • Days 1–60: After you pay your deductible, Medicare covers 100% of your inpatient hospital costs for the first 60 days.
  • Days 61–90: You pay a daily coinsurance amount of $434 per day.
  • Days 91 and beyond: You pay a daily coinsurance amount of $868 per day for each "lifetime reserve day" used. After you use all lifetime reserve days, you pay 100% of all costs.
  • Skilled Nursing Facility: Medicare covers 100% for days 1 through 20, but you pay a daily coinsurance for days 21 through 100.

You can learn more about extra coverage options like Medigap to help pay these costs through Think65.

Is it better to have medicare A and B or Medicare Advantage?

Neither option is universally "better"; Original Medicare (Parts A and B) and Medicare Advantage (Part C) serve different needs depending on your budget, health, and preference for doctors. You can review your official choices on the Medicare Coverage Options Page.

Original Medicare (Parts A & B)

  • How it works: Run directly by the federal government. Covers hospital care (Part A) and doctor visits (Part B).
  • Doctor choice: Go to any doctor or hospital in the U.S. that accepts Medicare without needing referrals.
  • Costs: No yearly limit on out-of-pocket costs unless you buy a separate Medigap (supplement) policy. You also need separate Part D for prescription drugs.
  • Best for: People who travel often within the U.S., want absolute freedom in choosing specialists, or prefer predictable coinsurance paired with a Medigap plan.

Medicare Advantage (Part C)

  • How it works: Offered by private insurance companies approved by Medicare. Combines Part A, Part B, and usually Part D (prescription drugs) into one plan.
  • Extra benefits: Often includes routine dental, vision, hearing, and gym memberships.
  • Costs: Features a mandatory yearly out-of-pocket maximum limit, but you must use specific provider networks (HMO or PPO) and may need prior approval for treatments.
  • Best for: People who want lower upfront or bundled monthly costs, desire extra perks like dental/vision, and stay within a local hospital or doctor network.

Do I need both A and B Medicare?

Yes, you need both Medicare Part A and Part B to have full Original Medicare coverage or to enroll in a private Medicare Advantage plan.

📋 Overview of Parts A and B

  • 🏥 Part A (Hospital): Covers inpatient care, skilled nursing, and hospice. It is usually premium-free.
  • 🩺 Part B (Medical): Covers doctor visits and outpatient care. It requires a monthly premium ($202.90 in 2026 for most).
  • ⚠️ Gaps: Part A alone leaves you with zero coverage for regular doctor visits or outpatient services.

🔎 When You Might Delay Part B

  • 💼 Working past 65: You can delay Part B without penalty if you have active employer coverage from a company with 20 or more employees.
  • 🛑 No active work: Delaying Part B without qualifying employer coverage triggers permanent late-enrollment penalties.

Does Medicare Part A pay for doctors in the hospital?

No, Medicare Part A does not cover doctor services while you are a hospital inpatient; instead, Medicare Part B covers those doctor fees.

How Hospital Coverage Works

  • Part A (Hospital Insurance): Covers the physical hospital stay itself, including your room, meals, general nursing care, operating room costs, medications given during your stay, and required lab tests or X-rays.
  • Part B (Medical Insurance): Covers the actual medical services provided by physicians, surgeons, and specialists during your inpatient stay.

Costs for Doctor Services in the Hospital

  • You must meet the annual Medicare Part B deductible.
  • After meeting the deductible, you generally pay 20% of the Medicare-approved amount for the doctor's services.

What Does Medicare Part A Cover?

9 related questions found

Is Medicare Part A free at age 65 for seniors?

Medicare Part A is free (has a $0 monthly premium) for most seniors aged 65 and older.

Who Gets Free Part A?

You do not pay a monthly premium for Part A if you or your spouse worked and paid Medicare taxes for at least 10 years (40 work quarters). About 99% of people qualify for this premium-free coverage.

Who Has to Pay for Part A?

If you do not have enough work credits, you can still buy Part A, but you will pay a monthly fee:

  • 30 to 39 work quarters: $311 per month
  • Fewer than 30 work quarters: $565 per month

Other Part A Costs

Even with a $0 monthly premium, Part A is not completely free when you use care. You still have out-of-pocket costs:

  • Hospital deductible: $1,736 per benefit period (in 2026)
  • Daily coinsurance: $0 for the first 60 days, but it increases for longer hospital stays or skilled nursing care.

You can review official details through the Fact Sheet on 2026 Medicare Costs.

What does Medicare Part A actually pay for?

Medicare Part A pays for inpatient care in hospitals, skilled nursing facilities, hospice care, and limited home health services.

✅ Covered Services & Facilities

  • 🏥 Inpatient Hospital Stays: Semi-private rooms, meals, general nursing, and drugs used during a formal inpatient admission.
  • 🛏️ Skilled Nursing Facility (SNF): Short-term rehabilitative care and nursing following a 3-day inpatient hospital stay.
  • 🕊️ Hospice Care: End-of-life comfort care, medical equipment, supplies, and support services for terminally ill individuals.
  • 🏠 Home Health Care: Part-time or intermittent skilled nursing and therapy if you are homebound.
  • 🧠 Inpatient Mental Health: Psychiatric care received while formally admitted to a hospital.

⚠️ Out-of-Pocket Costs (2026)

  • Deductible: $1,736 per benefit period before Medicare begins paying.
  • Hospital Coinsurance: $0 for days 1–60; $434 per day for days 61–90.
  • Skilled Nursing Coinsurance: $0 for days 1–20; daily coinsurance applies for days 21–100.

🚫 What Part A Does NOT Cover

  • Outpatient care (handled by Part B).
  • Long-term or custodial nursing home care.
  • Private-duty nursing or personal convenience items like phones and TVs in a hospital room.

Why do people say to stay away from Medicare Advantage plans?

Critics and beneficiaries advise caution with Medicare Advantage plans because of restrictions on care, unexpected costs, and administrative hurdles. While these private plans often feature low or zero monthly premiums and extra perks like dental or vision, they come with significant trade-offs.

Restricted Provider Networks

  • Local limitations: Most plans use specific HMO or PPO networks, meaning you must see doctors and go to hospitals within the plan’s local area.
  • No nationwide freedom: Unlike Original Medicare, which lets you see any accepting doctor nationwide, Medicare Advantage offers very limited coverage when traveling.
  • Frequent changes: Provider lists can change annually or even during the year, meaning your favorite doctor might leave the network unexpectedly.

Prior Authorization and Denials

  • Approval delays: Private insurers often require "prior authorization" (advance permission) for specialized care, MRIs, surgeries, or rehabilitation.
  • Care obstacles: This review process can delay or block medically necessary treatments.

High Out-of-Pocket Costs

  • Cost-sharing for serious illnesses: While plans have annual out-of-pocket maximums (up to thousands of dollars), treatments like chemotherapy or expensive infusions can trigger steep 20% coinsurance charges before you reach that cap.
  • End-of-life complications: High utilization during severe or chronic illness can result in major expenses or coverage friction.

The "Medigap" Trap

  • Locked-in coverage: If you try to switch back to Original Medicare after a 12-month trial period, moving to a Medicare Supplement (Medigap) plan often requires passing medical underwriting. Pre-existing health conditions can make it difficult or impossible to qualify for a good supplement later.

What are the biggest mistakes people make with Medicare?

The biggest mistake people make with Medicare is missing enrollment windows, which can lead to permanent financial penalties and coverage gaps.

Timing and Enrollment Mistakes

  • Missing Deadlines: Failing to sign up during your Initial Enrollment Period (IEP) around age 65 triggers lifelong financial penalties for Part B and Part D.
  • Misjudging Work Coverage: Assuming you can delay enrollment while working past 65 without checking if your employer plan is "creditable coverage" (plans with fewer than 20 employees often require Medicare to go first).
  • Missing the Medigap Window: Waiting past your 6-month Medigap Open Enrollment Period (which starts when you turn 65 and enroll in Part B) means you may have to pass medical underwriting to get a supplemental plan.

Plan Choice and Cost Mistakes

  • Focusing Only on Premiums: Choosing a plan with a low or $0 monthly premium without checking deductibles, copays, or maximum out-of-pocket costs.
  • Ignoring Annual Changes: Not reviewing your plan’s Annual Notice of Change (ANOC) or skipping the Annual Enrollment Period, which leads to surprise costs as drug formularies and doctor networks shift yearly.
  • Assuming Doctors are In-Network: Failing to verify if your preferred physicians and hospitals accept your specific Medicare Advantage or Part D network.
  • Thinking Medicare is Free: Forgetting that Original Medicare has monthly premiums, deductibles, and coinsurance, and does not cover routine dental, vision, or hearing care.

Can I drop my Medicare Advantage plan and go back to original Medicare?

Yes, you can drop your Medicare Advantage plan and return to Original Medicare, but you can usually only make this change during specific times of the year.

When You Can Switch

  • Annual Enrollment Period (October 15 – December 7): You can switch from a Medicare Advantage plan back to Original Medicare. The change takes effect on January 1 of the next year.
  • Medicare Advantage Open Enrollment Period (January 1 – March 31): If you already have a Medicare Advantage plan, you can drop it and return to Original Medicare during these months. The change takes effect the first of the month after the request is received.
  • Special Enrollment Periods: You can change plans outside these windows if you experience a qualifying life event, such as moving out of your plan's service area.

Important Things to Consider

  • Prescription Drug Coverage: Original Medicare does not include prescription drug coverage. If you leave Medicare Advantage, you should sign up for a stand-alone Medicare Part D prescription drug plan to avoid late enrollment penalties.
  • Medigap (Supplement Insurance): Original Medicare leaves out-of-pocket costs like co-pays and deductibles. You may want a Medigap policy to help pay these costs. However, outside your initial enrollment window or specific trial periods, insurance companies in most states can use medical underwriting to deny you a Medigap policy or charge higher rates based on your health.

How to Make the Switch

  • Call 1-800-MEDICARE (1-800-633-4227) for live assistance.
  • Contact your current Medicare Advantage plan to request cancellation.