Key Takeaways

• Medicare Part A covers inpatient hospital care, but it comes with significant out-of-pocket costs that can add up quickly during prolonged or repeated hospital stays.

• As a Postal Service Health Benefits (PSHB) enrollee, coordinating your PSHB coverage with Medicare can reduce your financial exposure and provide more predictable protection during a hospital stay.

Medicare Part A Basics: What It Covers

Medicare Part A primarily handles inpatient hospital services. This includes semi-private rooms, meals, nursing services, and certain drugs administered during your hospital stay. It also covers:

• Inpatient care in hospitals

• Skilled nursing facility care (under specific conditions)

• Hospice care

• Limited home health care services

Part A is often referred to as “hospital insurance,” but the name can be misleading. While it pays for many core inpatient services, there are multiple gaps that could result in significant out-of-pocket expenses.

The Gaps That Can Lead to Big Hospital Bills

Even though Medicare Part A covers a broad set of inpatient services, it doesn’t mean you’re fully protected financially. Here are the major cost-sharing components you’re responsible for in 2025:

• Inpatient hospital deductible: $1,676 per benefit period

• Daily coinsurance for long stays:

  • Days 1–60: $0 (after deductible)

  • Days 61–90: $419 per day

  • Days 91–150 (lifetime reserve days): $838 per day

  • After 150 days: All costs

As you can see, hospital costs beyond the first 60 days can quickly escalate. These amounts reset with each new benefit period, which starts after a patient has been out of the hospital for 60 consecutive days. This means if you’re hospitalized again after two months, a new deductible applies.

Skilled Nursing Facility Costs Under Part A

If you need follow-up care in a skilled nursing facility (SNF), Medicare Part A provides coverage—but only under specific circumstances. You must have:

• A qualifying hospital stay of at least three consecutive inpatient days

• Admission to the SNF within 30 days of discharge

• A need for daily skilled care

Even with coverage, you still face out-of-pocket expenses in 2025:

• Days 1–20: $0

• Days 21–100: $209.50 per day

• Beyond 100 days: All costs

Many people mistakenly assume that SNF stays are fully covered. But unless you leave the facility before Day 21, the coinsurance quickly adds up. And once you cross Day 100, you’re responsible for the entire bill.

Home Health and Hospice: Limited but Important Coverage

Part A also pays for some home health and hospice services, but only if certain conditions are met. For home health care, you must be homebound and require intermittent skilled nursing or therapy services. Hospice care requires certification of a terminal illness and a focus on palliative treatment.

While there’s generally no cost for hospice care under Part A, you may have to pay small copayments for medications or inpatient respite care. Home health services are typically covered in full, but durable medical equipment (like walkers or wheelchairs) may fall under Part B and involve separate costs.

What PSHB Enrollees Need to Consider

If you’re enrolled in the Postal Service Health Benefits (PSHB) Program, you already have access to a robust federal health insurance plan. But once you become eligible for Medicare, particularly around age 65, you need to decide how to coordinate your PSHB plan with Medicare Part A and B.

Here’s why this matters:

• PSHB plans often waive deductibles and coinsurance when you are enrolled in both Medicare Part A and B.

• Without Medicare Part B, your PSHB plan may become the primary payer and won’t coordinate benefits as effectively, potentially resulting in higher costs.

• Medicare Part A alone won’t eliminate all out-of-pocket expenses, especially for long hospital stays or SNF care.

How Coordination of Benefits Works

When you have both Medicare and a PSHB plan, Medicare typically pays first, and your PSHB plan covers some or all of the remaining costs. This reduces or eliminates your exposure to:

• The Part A hospital deductible

• Daily coinsurance for extended stays

• Coinsurance for skilled nursing care beyond Day 20

However, this cost-sharing relief is only possible if you are enrolled in both Medicare Parts A and B. Without Part B, your PSHB plan becomes the primary payer and may impose its own cost-sharing rules.

Medicare Part A Alone Leaves Gaps

Let’s say you rely only on Medicare Part A and skip Part B for now. You may think you’re covered because you have PSHB as a backup. But depending on your plan, you might face:

• Uncoordinated benefits: Your PSHB plan may treat you as if you’re fully responsible for the 80% of costs Medicare Part B would have paid.

• Full responsibility for Part A coinsurance and deductible amounts unless explicitly waived by your PSHB plan

• Limited financial protection in long or repeated hospitalizations

Why Medicare Part B Complements Part A So Well

Medicare Part B covers:

• Doctor visits during your hospital stay

• Outpatient services like lab tests, X-rays, and surgeries

• Durable medical equipment and ambulance services

Part B fills critical gaps that Part A does not touch. Since most PSHB plans are designed to work with both A and B, skipping Part B can cost you more in the long run.

In 2025, the standard Part B premium is $185 per month, and the deductible is $257. While this may feel like an extra expense, it provides access to full Medicare coordination, reducing or even eliminating other costs.

Avoiding Surprise Costs: What You Can Do Now

As you plan for Medicare eligibility, here are steps you can take to avoid surprise medical bills:

• Enroll in Medicare Part B when first eligible (typically at age 65) to ensure your PSHB plan will provide full secondary coverage

• Review your PSHB plan brochure to confirm how it coordinates with Medicare

• Understand the benefit period structure under Medicare Part A, as new hospitalizations may restart the deductible clock

• Consider how long-term hospital stays or SNF care could impact your budget if only Part A is in place

Hospital Care Costs Without PSHB or Part B Backup

If you depend solely on Medicare Part A without Part B or supplemental coverage, your financial risk increases significantly. For example:

• Two long hospital stays in the same year can trigger multiple deductibles

• Daily coinsurance after 60 days can cost thousands

• SNF stays beyond Day 20 become costly quickly

This scenario becomes even more serious if you have a chronic condition that results in frequent hospitalizations or rehab stays.

Why Postal Retirees Shouldn’t Rely on Part A Alone

As a PSHB enrollee, you may qualify for special benefits if you’re also enrolled in Medicare. Many PSHB plans offer:

• Reimbursement or waiver of Medicare Part B premiums

• Lower out-of-pocket costs once Medicare becomes primary

• Enhanced prescription drug coverage through integrated Medicare Part D

But you must be enrolled in both Parts A and B to access these benefits. Part A alone doesn’t trigger full coordination, meaning you may lose out on valuable cost savings.

Planning for Hospital Stays: Know the Timing and Triggers

A Medicare benefit period is not tied to a calendar year. It begins the day you’re admitted as an inpatient and ends when you’ve been out of the hospital or SNF for 60 consecutive days. If you’re readmitted after that, a new benefit period begins and the deductible resets.

This structure can be financially punishing if you have:

• Multiple unrelated hospitalizations throughout the year

• Conditions that result in periodic inpatient admissions

• Need for skilled nursing care more than once per year

Understanding this timing is essential for budgeting and planning, especially if you’re relying on Medicare Part A without full coordination.

The Bottom Line on Your Coverage Strategy

Medicare Part A gives you foundational coverage for inpatient hospital stays, but it was never designed to cover everything. High deductibles, coinsurance for longer stays, and benefit period resets can all result in unpredictable bills.

Your PSHB plan can significantly reduce your hospital-related expenses—but only if you’re also enrolled in Medicare Part B. Choosing to rely on Part A alone, even with PSHB in place, could leave you financially exposed in 2025 and beyond.

Protect Yourself From Big Hospital Bills With the Right Coverage Strategy

Medicare Part A is an essential starting point, but not the full solution. As a PSHB enrollee, your best protection comes from enrolling in both Medicare Part A and Part B, allowing your PSHB plan to step in with coordinated benefits that close costly coverage gaps.

To make sure you’re taking advantage of everything available to you, speak with a licensed agent listed on this website. They can help you understand how your PSHB plan works with Medicare and guide you through the best enrollment timing for your situation.