Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health care, but it leaves out a surprising number of services that many people assume are included. The gaps range from everyday needs like dental work and hearing aids to major expenses like long-term nursing home care, and understanding them can save you from unexpected bills.
Dental, Vision, and Hearing Services
Original Medicare, including Part A, does not cover routine dental care. That means cleanings, fillings, tooth extractions, and dentures all come out of your pocket. Even if you’re admitted to a hospital, routine dental work performed during your stay isn’t covered under Part A.
Eye exams for prescription glasses are also excluded, along with the glasses themselves. Hearing aids and the fitting exams that go with them fall into the same category. These three areas represent some of the most common ongoing health needs for older adults, yet Original Medicare treats them as outside its scope. Medicare Advantage plans (Part C) sometimes cover vision, hearing, and dental benefits, which is one reason many people choose them over Original Medicare.
Long-Term Nursing Home Care
This is one of the biggest and most costly gaps in Part A coverage. Medicare does not cover custodial care when it’s the only care you need. Custodial care means non-skilled personal help with daily activities: bathing, dressing, eating, getting in and out of bed, moving around, and using the bathroom. It can also include basic health tasks that most people do for themselves, like applying eye drops.
Most nursing home care is custodial. If you or a family member needs ongoing help with daily living but doesn’t require skilled medical treatment, Medicare won’t pay for it. This catches many families off guard because a short skilled nursing stay after a hospital admission is covered (up to 100 days per benefit period, with coinsurance kicking in after day 20). But once the need shifts from skilled rehabilitation to long-term personal care, coverage ends. Paying for long-term custodial care typically requires Medicaid, long-term care insurance, or personal funds.
Home Health Care Limits
Part A covers some home health services, but the list of what it won’t pay for is significant:
- 24-hour home care. Medicare doesn’t cover round-the-clock nursing or aide services in your home.
- Meal delivery. Programs like Meals on Wheels are not a Medicare benefit.
- Homemaker services. Shopping, laundry, and housecleaning that aren’t directly tied to your medical care plan are excluded.
- Custodial or personal care alone. If help with bathing, dressing, or toileting is the only care you need, Part A won’t cover it at home either.
Home health coverage under Part A requires that you be homebound and need skilled nursing or therapy services ordered by a doctor. Once those skilled needs are met or no longer apply, the home health benefit stops, even if you still need personal assistance.
Care Outside the United States
As a general rule, Medicare does not pay for health care you receive outside the country. There are only three narrow exceptions where Part A may cover inpatient care at a foreign hospital:
- Nearest hospital in an emergency. You have a medical emergency while in the U.S., and the closest hospital that can treat you happens to be across the border in Canada or Mexico.
- Traveling through Canada. You’re traveling the most direct route between Alaska and another state, a medical emergency occurs, and a Canadian hospital is closer than any U.S. hospital.
- You live near the border. Your home is in the U.S., but a foreign hospital is closer than the nearest U.S. hospital that can treat your condition.
Outside these situations, a hospital stay in another country is entirely your responsibility. If you travel internationally, separate travel medical insurance is worth considering.
The Observation Status Problem
You can spend multiple nights in a hospital bed, receive treatment from hospital staff, and still not be covered under Part A. The reason is observation status. If your doctor hasn’t written an order formally admitting you as an inpatient, you’re classified as an outpatient, even if you sleep at the hospital overnight. Observation services are outpatient services used while your doctor decides whether to admit you or send you home.
This distinction has real financial consequences. As an outpatient, your costs are billed under Part B rules, which means different copayments for services, drugs, and tests. Your total copayments for outpatient services can actually exceed the Part A inpatient deductible. Perhaps more importantly, observation days don’t count toward the three-day inpatient stay required to qualify for skilled nursing facility coverage after discharge. So if you spend two nights under observation and one night as a formal inpatient, Medicare won’t cover a rehab stay afterward.
If you’re in a hospital for more than 24 hours under observation, the hospital is required to give you a Medicare Outpatient Observation Notice (MOON) explaining your status and how it affects your costs.
Doctor Services During a Hospital Stay
Part A covers the hospital itself: your room, meals, nursing care, and general hospital services. But the doctors who treat you during your stay bill separately under Part B. This includes surgeons, anesthesiologists, radiologists, and any specialists who see you. If you don’t have Part B, those physician charges are not covered, even though the care happened inside a hospital during an inpatient admission covered by Part A.
Blood Costs in the First Three Pints
If you need a blood transfusion during a hospital stay, Part A covers it, but with a catch. You’re responsible for the cost of the first three pints of blood you receive in a calendar year. You can avoid this charge if you or someone else donates blood to replace it. After those first three pints, Part A covers additional blood at no extra cost to you for the remainder of that calendar year.
Private Duty Nursing and Comfort Items
Part A covers the nursing staff assigned to you by the hospital or skilled nursing facility, but it does not cover private duty nursing. If you want a dedicated nurse providing one-on-one care beyond what the facility normally provides, that cost is yours. Comfort and convenience items like a television or phone in your hospital room are also excluded from Part A coverage.
What You Still Pay Even When Part A Applies
Even for services Part A does cover, you’re not off the hook for all costs. In 2025, the inpatient hospital deductible is $1,676 per benefit period. If your hospital stay extends beyond 60 days, you pay $419 per day for days 61 through 90. Beyond 90 days, you tap into a limited pool of 60 lifetime reserve days at $838 per day. Once those are gone, you pay the full cost.
For skilled nursing facility stays, days 1 through 20 are fully covered after you meet the conditions. Days 21 through 100 come with a daily coinsurance of $209.50 in 2025. After day 100, Medicare stops paying entirely. These costs add up quickly, which is why many people carry supplemental insurance (Medigap) or choose a Medicare Advantage plan to limit their out-of-pocket exposure.