Part A Might Not Cover the Length of Stay You Thought It Would

Key Takeaways

• Medicare Part A may not cover the full duration of your hospital or skilled nursing facility stay, leading to unexpected out-of-pocket costs if you aren’t prepared.

• As a PSHB enrollee, understanding the day limits and cost-sharing rules in 2025 is critical to ensuring you don’t miscalculate your coverage timeline.

What Part A Covers—And What It Doesn’t

Medicare Part A is often associated with hospital insurance. It typically covers inpatient hospital care, skilled nursing facility (SNF) care, hospice, and some home health care services. But there’s a critical catch: this coverage is tied directly to specific benefit periods, strict day limits, and cost-sharing requirements.

Here’s what you need to know:

Hospital Inpatient Stays

• Medicare Part A covers hospital stays up to 90 days per benefit period.

• You also receive 60 lifetime reserve days—a one-time allotment for hospital stays that go beyond 90 days.

• In 2025, the inpatient deductible is $1,676 per benefit period. After 60 days, you begin paying daily coinsurance:

  • Days 61–90: $419 per day

  • Lifetime reserve days: $838 per day

This means if your stay goes beyond 90 days and you’ve exhausted your lifetime reserve days, Medicare Part A will no longer pay for inpatient care.

Skilled Nursing Facility (SNF) Care

SNF care is commonly misunderstood. In 2025, Medicare Part A covers up to 100 days in a SNF per benefit period—but only under strict conditions:

• You must first have a qualifying 3-day inpatient hospital stay.

• The SNF care must be for the same condition you were hospitalized for.

• Daily coinsurance begins after day 20:

  • Days 21–100: $209.50 per day

If your SNF care continues beyond 100 days, or you didn’t meet the 3-day rule, Part A pays nothing further.

Benefit Periods Reset—And That Can Be a Problem

Medicare uses what’s called a benefit period to track how long your coverage applies. A benefit period begins the day you’re admitted to a hospital or SNF and ends when you haven’t received inpatient or SNF care for 60 consecutive days.

This means that if you’re hospitalized again after 60 days have passed, you start a new benefit period:

• A new deductible applies.

• The day count resets.

• Lifetime reserve days are only used once—they do not reset.

For PSHB retirees, these resets can quietly restart your cost-sharing responsibilities multiple times in a single year.

Why PSHB Members Need to Watch the Clock

As a Postal Service Health Benefits enrollee, your plan may offer additional coverage that supplements Medicare. However, many PSHB plans coordinate with Medicare rather than fully replacing it. That makes the Medicare rules especially important to follow.

Some things to watch in 2025:

• Your PSHB plan may not cover what Medicare denies once the benefit period ends.

• Cost-sharing gaps—especially after SNF day 20 and hospital day 60—can escalate quickly.

• If you’re discharged and re-admitted, a new benefit period may restart your deductible, even within the same calendar year.

Hospital Readmission: A Financial Risk

Let’s say you are discharged and then readmitted to the hospital within 60 days—you are still within the same benefit period. This is favorable because you won’t pay a new deductible. But if the readmission happens after 60 days:

• It triggers a new benefit period.

• You pay the $1,676 deductible again.

• The day count for coinsurance restarts.

This rule can result in multiple deductibles and out-of-pocket costs in a single year for retirees or chronically ill enrollees.

Hospice and Home Health: Limited by Scope

Part A also covers hospice care and certain home health services, but both come with limitations:

• Hospice care is available if your doctor certifies a terminal illness with a life expectancy of 6 months or less.

• Home health services are covered under strict medical necessity and must be provided by a Medicare-certified agency.

Neither of these categories allows indefinite use. They’re based on medical documentation and periodic re-certification. If criteria aren’t met, you may be transitioned off covered services.

Medicare Part A Doesn’t Cover Everything

Even during covered hospital stays, certain costs are not included:

• Private-duty nursing

• Personal convenience items (TV, phone, toiletries)

• First three pints of blood (unless replaced)

• Long-term custodial care

This is where coordination with your PSHB plan becomes crucial. You need to verify what supplemental coverage kicks in where Medicare ends. Not all PSHB plans pick up the slack equally.

What Happens After 100 Days in a Skilled Nursing Facility?

Once Medicare Part A stops coverage at day 101 in a skilled nursing facility, you bear the full cost unless your PSHB plan includes extended SNF coverage.

In 2025, the average cost of skilled nursing care ranges widely but often exceeds $300 per day—a major financial exposure.

Your PSHB plan may offer partial or full cost-sharing for SNF care beyond 100 days, but this varies by plan. If you assume that Medicare will keep paying, you may find yourself responsible for thousands in uncovered expenses.

Coordinating PSHB With Medicare: Avoiding Surprises

Coordination of benefits is key. In general, when you’re retired and over 65, Medicare pays first, and your PSHB plan is secondary. This coordination only works well if you’re aware of what each side covers.

Steps to protect yourself:

• Review your PSHB plan’s Explanation of Benefits (EOB) for inpatient and SNF coverage limits.

• Ask whether your plan extends SNF coverage beyond the 100-day Medicare limit.

• Find out how your PSHB plan handles lifetime reserve days or benefit period resets.

• Keep documentation of hospital stays and SNF dates—this is critical if you appeal denied claims.

Don’t Assume Part A Means Full Coverage

It’s easy to hear “hospital insurance” and assume Medicare Part A will fully handle your care. But in reality, the coverage has strict boundaries—especially in 2025 as healthcare costs and admissions increase.

• The 90-day hospital cap is stricter than many realize.

• Lifetime reserve days are finite and non-renewable.

• SNF stays must meet exact criteria, or Part A pays nothing.

Your PSHB plan can help—but only if you understand where Medicare stops and where your plan begins.

How to Plan for Extended Care Needs

Many PSHB retirees are surprised when extended hospital stays or SNF care outlast Medicare coverage. That’s why proactive planning matters.

Here’s what to do now:

• Talk with a licensed agent listed on this website to understand your full benefit design.

• Evaluate whether you need additional protection for long-term care or supplemental coverage.

• Don’t wait until you’re already admitted—review your plan before a health event occurs.

Make Your Coverage Work for You in 2025

In 2025, you can’t afford to make assumptions about Medicare Part A timelines or limits. As a PSHB member, your decisions about Medicare enrollment, benefit period tracking, and cost-sharing preparedness will directly affect your financial and medical outcomes.

Whether you’re newly retired or years into retirement, now is the right time to reassess your coverage structure. Benefit periods, deductibles, and day limits won’t adjust themselves—you have to.

To get clarity on your full range of coverage and next steps, get in touch with a licensed agent listed on this website. They can help you understand how to coordinate PSHB and Medicare to minimize exposure and avoid costly mistakes.