Medicare Part A

Medicare Part A is your hospital insurance. It covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. For most people, Part A comes at no cost — it’s an entitlement you’ve already earned through payroll taxes paid while you or your spouse were working.

You qualify for premium-free Part A if:

• You or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters), and
• You’ve been a permanent, legal U.S. resident for at least five continuous years

If you don’t meet those criteria — which is uncommon — you can purchase Part A coverage. The monthly premium amount depends on how many years you or your spouse worked and is set by Medicare each year.

How the Part A Deductible Works

Part A doesn’t have a simple annual deductible like most insurance plans. It uses what Medicare calls a benefit period deductible — and understanding this distinction matters.

A benefit period begins the day you’re admitted as an inpatient to a hospital or skilled nursing facility. It ends once you’ve gone 60 consecutive days without inpatient or skilled nursing care. When a new benefit period begins, the deductible resets — meaning you could pay it more than once in a single calendar year if you have multiple separate hospital stays.

Medicare updates the benefit period deductible amount annually. Check Medicare.gov each fall for the current year’s figure.

Inpatient Hospital Coverage

• Once you’ve met your benefit period deductible, here’s how cost-sharing works based on length of stay:

  Days 1–60: Your deductible covers this period. No additional daily cost-sharing.

  Days 61–90: You’ll owe a daily coinsurance amount for each day in this range. Medicare sets this figure each year — it’s roughly one-quarter of the benefit period deductible.

  Days 91 and beyond (Lifetime Reserve Days): You have a 60-day lifetime reserve you can draw on. During these days, your daily coinsurance is higher — roughly half the benefit period deductible. Once lifetime reserve days are used, they’re gone permanently.

  Beyond lifetime reserve: You’re responsible for 100% of costs.

  Psychiatric inpatient care is covered somewhat differently, with a 190-day lifetime benefit limit and some modified cost-sharing rules.

  The longer the hospital stay, the more significant these costs become. This is one of the most commonly cited limitations of Original Medicare — there is no out-of-pocket maximum on the hospital side. Costs can compound quickly for extended stays, which is why many people choose a Medicare Supplement (Medigap) plan to cover these gaps.

Skilled Nursing Facility Coverage

Medicare Part A also covers short-term skilled nursing facility (SNF) care — but this is not long-term care, and it’s not custodial care. Medicare does not cover assistance with Activities of Daily Living (bathing, eating, mobility, etc.). SNF coverage is meant to bridge the gap between a hospital stay and returning home or transitioning to a long-term care facility.

Coverage tiers:

• Days 1–20: Covered in full — no cost to you
• Days 21–100: You pay a daily coinsurance amount (set annually by Medicare)
• Day 101 and beyond: You’re responsible for 100% of costs

Important: To qualify for Medicare-covered SNF care, you must first have a qualifying inpatient hospital stay of at least three days. Observation stays — even if you’re physically in a hospital bed — do not count. This catches a lot of people off guard, so it’s worth knowing before a situation arises.

What Part A Doesn’t Cover

A few things worth knowing upfront:

• Long-term care is not covered. Medicare is not a substitute for long-term care insurance.
• Custodial care — help with daily living activities — is not covered.
• Most dental, vision, and hearing care falls outside Part A coverage.

The Bottom Line on Part A

For most people, Part A is solid foundational coverage for hospital and skilled nursing care, with no premium cost. The areas to watch are the benefit period deductible structure (which can repeat within a year), the daily coinsurance that kicks in for longer stays, and the hard stop at 100% responsibility once certain thresholds are crossed.

These gaps are exactly what Medicare Supplement plans are designed to address. If you’re weighing your coverage options, understanding what Part A leaves exposed is a good place to start.