The Hospital Stay Timeline That Determines How Much You Owe with Medicare Part A

Key Takeaways

• Medicare Part A only fully covers the first 60 days of an inpatient hospital stay; after that, costs rise quickly—especially if you’re not coordinating benefits with your PSHB plan.

• Understanding the timeline of hospital coverage under Part A is crucial to avoid surprise bills and to protect your retirement budget.

Why the Timeline of a Hospital Stay Matters So Much

When you’re covered by both Medicare Part A and a Postal Service Health Benefits (PSHB) plan, it’s easy to assume you’re protected from most hospital bills. But that protection has very real time limits. Medicare Part A follows a strict benefit period structure, and once you cross certain thresholds, the financial burden shifts sharply onto your shoulders—unless you’ve planned accordingly.

Every day of a hospital stay counts. Medicare doesn’t just look at your admission and discharge dates; it follows defined periods and rules. And these rules don’t always align neatly with how your PSHB plan coordinates. If you don’t pay attention to where you fall on the timeline, you could face significant out-of-pocket costs.

What Medicare Part A Covers Up Front

Let’s start with what’s covered in full. When you’re admitted as an inpatient to a hospital, Medicare Part A provides coverage in structured intervals called benefit periods. Each period begins on the day you enter the hospital and ends after you’ve been out of the hospital (or a skilled nursing facility) for 60 consecutive days.

During each benefit period:

• Days 1–60: You pay the Part A deductible (in 2025, that’s $1,676). After that, Medicare covers all approved hospital costs.

• Days 61–90: You’re responsible for a daily coinsurance of $419 per day.

• Days 91–150: Medicare allows you to use up to 60 lifetime reserve days, with a daily coinsurance of $838. These reserve days are nonrenewable.

• Day 151 and beyond: Medicare no longer pays anything. You cover the full cost unless another plan—like your PSHB—picks up the bill.

The Clock Starts on Day One

The benefit period clock starts ticking from the day you’re admitted as an inpatient. This is not the same as being under observation or in the ER; your hospital status must be formally admitted for Part A to kick in.

This timeline resets only after you’ve been out of the hospital or skilled nursing care for 60 days. That’s important—because if you’re readmitted before that 60-day mark, it’s considered the same benefit period. That means you don’t get another 60 fully covered days, and you may immediately fall into the coinsurance phase.

Example Breakdown (No Real Names Used)

• Inpatient Day 1: $1,676 deductible due.

• Days 2–60: Covered by Medicare.

• Day 61: $419 per day coinsurance begins.

• Day 91: Lifetime reserve days start, with $838 coinsurance.

• Day 151: No coverage from Medicare Part A.

How the PSHB Plan Factors In

Your PSHB plan acts as a crucial safety net, especially after Medicare coverage declines. Many PSHB plans reduce or eliminate coinsurance for days 61–90 and may even cover some or all of your costs after Medicare’s 150-day limit. However, these benefits vary by plan, and you must be enrolled in both Medicare Part A and your PSHB plan to receive full coordination.

Here’s what your PSHB plan may help with:

• Covering the coinsurance for days 61–90

• Picking up the tab for all or part of your lifetime reserve day costs

• Offering continued inpatient coverage after 150 days, depending on the plan

Still, the key here is coordination. If you didn’t enroll in Medicare Part B, for example, some PSHB plans may reduce their payment obligations, leaving you responsible for more out-of-pocket costs.

Hospital Status Impacts Your Coverage

Another hidden issue in all of this is your hospital admission status. If you’re treated for days in a hospital but never formally admitted, you could be classified as an outpatient under observation. In this case, Medicare Part A doesn’t apply—your costs would instead fall under Part B, and your PSHB plan would coordinate differently.

Always confirm your status. Many retirees don’t realize they’re under observation until they see the bill. If you’re not admitted, you don’t trigger a benefit period, and the inpatient timeline (and coverage) never begins.

Readmission Doesn’t Always Mean New Coverage

Many assume that if they’re readmitted to the hospital weeks after discharge, they get a new set of benefits. That’s not the case. Unless you’ve been out of the hospital (and out of skilled nursing care) for 60 straight days, any return to the hospital continues the same benefit period. You’re not resetting the clock—you’re picking up where you left off.

This can be particularly dangerous if your initial stay was long. A readmission could mean you’re already deep into the coinsurance phase or even past your 150-day limit.

Skilled Nursing Facility (SNF) Days Count Too

It’s not just hospitals that affect your benefit period. If you’re discharged to a skilled nursing facility after an inpatient hospital stay, those SNF days also count toward your benefit period.

For Medicare to cover skilled nursing care:

• You must have had at least a three-day inpatient hospital stay (not counting observation).

• You must enter the SNF within 30 days of discharge.

Coverage includes:

• Days 1–20: Fully covered

• Days 21–100: $209.50 per day coinsurance in 2025

• After day 100: You pay the full cost

If you don’t meet these criteria, Medicare won’t pay for your SNF stay at all—even if you thought you were covered.

Planning Ahead Prevents Financial Shock

The number one mistake retirees make is assuming their health insurance will work itself out. The PSHB program offers strong benefits, especially when paired with Medicare. But both programs operate under specific timelines, coverage periods, and rules.

Take these steps to prepare:

• Track hospital days carefully. Ask your care team to confirm your admission status and days used.

• Review your PSHB plan. Know exactly what it covers after Medicare stops.

• Don’t assume readmission resets the clock. Remember the 60-day rule.

• Enroll in both Medicare Parts A and B. Many PSHB plans require both to provide full coordination of benefits.

• Request itemized bills. These can help you track coverage phases and ensure your benefits are applied correctly.

PSHB and Medicare: A Timeline Worth Understanding

The reality is that hospital stays—especially long ones—can unravel your budget if you don’t fully understand the timeline Medicare Part A follows. The Part A benefit period is not based on calendar years or admission counts but on exact durations and gaps in care. Your PSHB plan can be a major financial backstop, but it only helps if you’ve structured your coverage properly.

Protect yourself by knowing the specifics. Pay close attention to your admission dates, benefit periods, and coinsurance phases. Always verify how your PSHB plan coordinates with Medicare, and if you’re unsure, reach out for help.

Speak to a Licensed Agent Today

If you’re uncertain how your PSHB plan interacts with Medicare—especially in complex hospitalization scenarios—don’t guess. Get in touch with a licensed agent listed on this website to review your options and confirm how your benefits work together. It’s the best way to avoid costly surprises down the road.