Medicare Part A: What Hospital Insurance Covers and Costs

Medicare Part A is called Hospital Insurance, but it covers more than hospital stays. It also helps pay for short-term care in a skilled nursing facility, hospice care and some home health care.

Part A has its own vocabulary, like "benefit periods" and "lifetime reserve days." This guide explains what Part A covers, what it costs, and the inpatient-versus-outpatient rule that trips up many families.

This is general information, not insurance or medical advice, and this independent site is not connected with Medicare or CMS. Your costs may differ if you are in a Medicare Advantage Plan or have other coverage. For help with a specific situation, contact your State Health Insurance Assistance Program (SHIP) or call 1-800-MEDICARE (1-800-633-4227).

What Part A covers

According to Medicare.gov, Part A helps pay for inpatient care in hospitals, critical access hospitals and skilled nursing facilities, plus hospice care and some home health care. For a hospital stay, covered services include a semi-private room, meals, general nursing, and drugs and supplies that are part of your inpatient treatment.

Medicare.gov lists several things Part A doesn't pay for during a stay: private-duty nursing, a private room unless it's medically necessary, a TV or phone if the hospital charges separately, and personal care items like razors or slipper socks. Doctors' services in the hospital fall under Part B, not Part A. If you have Part B, Medicare.gov's inpatient care page (2026) says it generally covers 80% of the Medicare-approved amount for those services.

Do you pay a premium for Part A?

Most people don't. Medicare.gov says that for 2026, most people pay $0 for Part A because they or a spouse paid Medicare taxes long enough while working, generally at least 10 years. Medicare.gov adds that if you get Medicare before age 65, you won't pay a Part A premium.

If you don't qualify for premium-free Part A, you may be able to buy it. CMS's 2026 fact sheet sets the monthly buy-in premium for 2026 at $311 for people with at least 30 quarters of covered work (or a spouse with 30 quarters) and $565 for those with fewer than 30. The Medicare & You 2027 handbook adds that in most cases, if you buy Part A you must also have Part B.

Benefit periods: how Part A measures your care

Part A doesn't use a calendar-year deductible the way many plans do. It uses benefit periods. The Medicare & You 2027 handbook defines a benefit period as starting the day you're admitted as an inpatient to a hospital or skilled nursing facility. It ends when you haven't had inpatient hospital care or skilled nursing care for 60 days in a row. There's no limit on the number of benefit periods, so you can pay the deductible more than once in a year.

For 2026, Medicare.gov lists these Original Medicare amounts for each benefit period in a hospital:

• Days 1–60: a $1,736 deductible in 2026, then $0 per day
• Days 61–90: $434 per day in 2026
• Days 91–150: $868 per day in 2026, using lifetime reserve days
• After day 150: you pay all costs

Medicare.gov explains that you have 60 lifetime reserve days in total, and once used they don't come back. It also notes a separate 190-day lifetime limit on inpatient care in a freestanding psychiatric hospital. That limit doesn't apply to psychiatric units inside general hospitals.

For example, imagine someone who is hospitalized in February, goes home, and is readmitted in May, more than 60 days after going home, with no inpatient or skilled nursing care in between. Because the first benefit period ended, the May stay starts a new one, and the Part A deductible applies again.

Inpatient or outpatient? Ask every day

Your hospital status changes what you pay and whether later nursing home care is covered. Medicare.gov explains that you're an inpatient only once the hospital formally admits you with a doctor's order. If you're getting emergency department care, observation services, outpatient surgery or tests without an admission order, you're an outpatient. That's true even if you spend the night in a regular hospital bed.

Observation services are outpatient care you get while the doctor decides whether to admit you. Medicare.gov says an inpatient admission is generally appropriate when you're expected to need 2 or more midnights of medically necessary hospital care, but the doctor still has to order it. If you're under observation for more than 24 hours, the hospital must give you a Medicare Outpatient Observation Notice (MOON) explaining your status.

Medicare.gov's advice: each day you stay, ask the doctor or hospital staff whether you're an inpatient or an outpatient.

Skilled nursing facility care after a hospital stay

Part A covers short-term skilled nursing or rehabilitation care, not long-term living assistance. To qualify, Medicare.gov says you generally need:

• A qualifying inpatient hospital stay of at least 3 days in a row, counting the day you were admitted but not the day you left
• Admission to a Medicare-certified skilled nursing facility, generally within 30 days of leaving the hospital
• A doctor's determination that you need daily skilled care, such as intravenous medications or physical therapy

Days spent under observation or in the emergency room before admission don't count toward the 3 days. Medicare.gov notes that some Accountable Care Organizations approved for a waiver, and some Medicare Advantage Plans, may waive the 3-day rule.

For 2026, Medicare.gov lists these Original Medicare amounts for each benefit period in a skilled nursing facility: $0 per day for days 1–20, $217 per day for days 21–100, and all costs after day 100. You don't pay the Part A deductible again if you already paid it for a hospital stay in the same benefit period.

Hospice and home health care

Hospice is comfort-focused care for people who are terminally ill. According to the Medicare & You 2027 handbook, a hospice doctor and your primary care doctor (if you have one) must certify a life expectancy of 6 months or less. You also agree to comfort care instead of treatment to cure the illness. For 2026, Medicare.gov lists $0 for covered hospice services, a copayment of up to $5 per prescription for pain and symptom drugs, and 5% of the Medicare-approved amount for inpatient respite care. Room and board generally isn't covered. Medicare.gov also says you can stop hospice at any time.

Home health care is covered under both Part A and Part B. Medicare.gov says you must be homebound and need part-time or intermittent skilled care, such as skilled nursing or therapy. A doctor or other qualified provider must certify your need and order the care, and a Medicare-certified agency must provide it. Medicare.gov lists $0 for covered home health services in 2026, with 20% coinsurance for durable medical equipment.

What Part A won't pay for: long-term care

The biggest misunderstanding concerns nursing homes. Medicare.gov is clear that Medicare doesn't pay for long-term care, meaning non-medical help with daily activities like bathing, dressing and using the bathroom. That's true whether the care happens at home or in a nursing home, and most Medigap policies don't cover it either. Medicaid (if you qualify in your state) or private long-term care insurance may help. For questions about long-term care insurance, Medicare.gov suggests calling your state insurance department.

Key takeaways

• Part A covers inpatient hospital care, short-term skilled nursing facility care, hospice and some home health care.
• Most people pay no Part A premium. For 2026, CMS lists buy-in premiums of $311 or $565 a month for those who don't qualify.
• Costs are measured per benefit period. For 2026, Medicare.gov lists a $1,736 deductible for each benefit period, and you can pay it more than once in a year.
• Being "under observation" makes you an outpatient, which can affect your bill and your skilled nursing coverage, so ask about your status daily.
• Skilled nursing coverage usually requires a 3-day inpatient stay and is limited to 100 days per benefit period. Long-term custodial care isn't covered.

Sources

• Medicare.gov, What Part A covers
• Medicare.gov, Inpatient hospital care
• Medicare.gov, Inpatient or outpatient hospital status affects your costs
• Medicare.gov, Skilled nursing facility care
• Medicare.gov, Costs (2026 amounts)
• Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles (November 14, 2025)
• Centers for Medicare & Medicaid Services, Medicare & You 2027 (official U.S. government Medicare handbook)
• Medicare.gov, Long-term care
• Medicare.gov, Hospice care
• Medicare.gov, Home health services