Key Takeaways

• Medicare Part A covers a wide range of hospital-related services, but it does not pay for everything. You are still responsible for several out-of-pocket costs including deductibles, coinsurance, and non-covered services.

• As a Postal Service Health Benefits (PSHB) enrollee, your Part A coverage may coordinate with your PSHB plan to reduce your share of costs, but only if you are enrolled in both correctly and on time.

What Medicare Part A Covers in 2025

Medicare Part A is often called “hospital insurance” for a reason. It provides foundational coverage for inpatient services. As of 2025, Medicare Part A includes the following key benefits:

Inpatient Hospital Stays

When you are admitted to a hospital as an inpatient, Medicare Part A helps pay for:

• Semi-private rooms

• Meals

• General nursing

• Drugs as part of your inpatient treatment

• Other hospital services and supplies

However, this coverage is limited by the number of days you stay and the facility’s Medicare approval.

Skilled Nursing Facility (SNF) Care

Medicare Part A covers skilled nursing care under specific conditions:

• You must have a qualifying hospital stay of at least 3 consecutive days as an inpatient.

• You must enter the SNF within 30 days of leaving the hospital.

• The care must be medically necessary and ordered by your doctor.

In 2025, Medicare pays fully for days 1 to 20, but starting on day 21, you’re responsible for daily coinsurance.

Home Health Care

While Medicare Part A provides limited home health services, it covers:

• Part-time or intermittent skilled nursing care

• Physical therapy

• Occupational therapy

• Speech-language pathology

This benefit requires a doctor’s certification and a Medicare-certified agency to administer the services.

Hospice Care

Medicare Part A fully covers hospice care for individuals certified as terminally ill with a life expectancy of six months or less. Covered services include:

• Pain relief and symptom management

• Nursing and medical services

• Certain prescription drugs

• Counseling and respite care

What You Still Pay Even with Part A

Even though Medicare Part A is often referred to as premium-free, it does not eliminate your out-of-pocket expenses. These gaps in coverage can be significant.

Deductibles and Coinsurance

In 2025, the Medicare Part A inpatient hospital deductible is $1,676 per benefit period. This amount resets with each new benefit period, not annually.

Coinsurance applies as follows:

• Days 1–60: You pay $0 coinsurance after the deductible.

• Days 61–90: You pay $419 per day.

• Days 91 and beyond: You use your 60 lifetime reserve days, paying $838 per day.

• After lifetime reserve days are used: You pay all costs.

Skilled nursing coinsurance in 2025 is $209.50 per day for days 21 through 100. After 100 days, you are responsible for the full cost.

Non-Covered Services

Medicare Part A does not cover:

• Long-term custodial care (help with bathing, dressing, eating)

• Private-duty nursing

• A private room unless medically necessary

• TV, phone, or personal comfort items in a hospital room

• Blood unless it is donated or replaced

These services either require full out-of-pocket payment or supplemental coverage.

Timing and Coordination with PSHB Plans

If you’re enrolled in a PSHB plan and become eligible for Medicare at age 65, how you time your enrollment matters significantly. Coordination of benefits between PSHB and Medicare can reduce your out-of-pocket exposure, but it hinges on:

• Enrolling in Medicare Part A and Part B at age 65

• Making sure your PSHB plan is aware of your Medicare status

Primary vs. Secondary Payer Rules

When you have both Medicare and a PSHB plan:

• Medicare usually pays first once you retire and turn 65.

• Your PSHB plan becomes the secondary payer and may cover deductibles or coinsurance not paid by Medicare.

Failing to enroll in Medicare when required can shift full cost responsibility to you, as PSHB plans may pay less if you were eligible for Medicare but did not enroll.

Understanding Benefit Periods

Medicare Part A operates on benefit periods, not calendar years. This distinction affects how often you may face the inpatient deductible.

How Benefit Periods Work

• A benefit period starts when you are admitted to a hospital or SNF.

• It ends when you haven’t received inpatient care for 60 consecutive days.

• If you are admitted again after 60 days, a new benefit period begins, and a new deductible applies.

This means you could be responsible for multiple deductibles in one year if you are hospitalized more than once.

How Your Costs Can Add Up

Even if you have what appears to be full coverage through Medicare Part A, out-of-pocket expenses can mount quickly. Here’s how:

• One hospital stay over 90 days could exhaust your lifetime reserve days.

• Extended skilled nursing care beyond 20 days results in daily coinsurance.

• Non-covered services like custodial care or a private room can lead to major bills.

Without Medicare Part B, your PSHB plan may not fully fill these gaps. Most cost-sharing arrangements assume you’re enrolled in both Medicare A and B.

Postal Service Annuitants: Unique Considerations

As a Postal Service annuitant, your health benefits now fall under the PSHB program. Beginning in 2025, specific Medicare integration rules apply:

• If you were retired on or before January 1, 2025, and not enrolled in Medicare Part B, you are exempt from mandatory enrollment.

• If you retired after January 1, 2025, and are eligible for Medicare, you are required to enroll in both Part A and Part B to keep PSHB coverage.

This rule affects your ability to receive secondary coverage for what Part A does not pay.

What to Do Before You Turn 65

To make sure you don’t fall into coverage gaps:

• Enroll in Medicare Part A three months before your 65th birthday. Most people are automatically enrolled if they’re receiving Social Security.

• Consider enrolling in Medicare Part B unless you’re exempt. This is required to receive full PSHB benefits.

• Verify your PSHB plan’s coordination process. Ensure they recognize Medicare as primary and will pay secondary.

• Update your records with both Medicare and OPM. Proper documentation prevents billing errors.

When PSHB Helps Fill the Gaps

Your PSHB plan can be especially valuable when used alongside Medicare. While Medicare Part A covers the bulk of your hospital-related expenses, your PSHB plan may:

• Pay some or all of your hospital coinsurance

• Cover some costs of non-Medicare services

• Include out-of-pocket maximums to limit your total annual spending

• Provide prescription drug coverage through a Medicare Part D EGWP if you’re Medicare-eligible

However, these benefits are not automatic. They depend on correct and timely enrollment in both systems.

If You Skip Medicare Enrollment

Some retirees believe they can rely solely on their PSHB coverage after age 65. This can be a costly mistake:

• PSHB plans will coordinate as if you had Medicare, even if you didn’t enroll. This means they will pay less.

• You may end up responsible for full hospital bills that Medicare Part A would have covered.

• You may miss your Initial Enrollment Period and have to wait for the General Enrollment Period, facing late penalties and delays in coverage.

In 2025, those penalties are still in place, and coverage delays can last up to six months depending on when you enroll.

What to Ask a Licensed Agent

To understand how Medicare Part A and PSHB work together, consider asking:

• How will my PSHB plan coordinate benefits with Medicare Part A?

• What happens if I don’t enroll in Part B?

• Will my PSHB plan pay for services that Medicare doesn’t cover?

• What cost-sharing am I responsible for if I have both Medicare and PSHB?

Clear answers to these questions can help you make a financially sound choice.

Why Planning Ahead Protects You

Many of the hospital costs that Part A doesn’t cover can be anticipated, but only if you act early. Understanding what is and isn’t covered, the timing of benefit periods, and how PSHB integrates with Medicare helps reduce unexpected bills.

PSHB coverage is designed to work with Medicare, not replace it. If you plan accordingly, you can minimize or even eliminate many of the out-of-pocket hospital costs that otherwise fall to you.

Take Steps to Protect Your Coverage Now

If you’re approaching age 65 or already enrolled in PSHB, this is the time to act. Medicare Part A does a lot, but not everything. With proper coordination, your PSHB plan can help pick up the pieces, but only if you’re enrolled and aligned with Medicare rules. Get in touch with a licensed agent listed on this website to go over your specific coverage and confirm that you’re protected from unexpected medical bills.