Key Takeaways

• Medicare Part A provides vital hospital coverage but comes with significant out-of-pocket costs that can surprise many Postal Service Health Benefits (PSHB) enrollees.

• Understanding the specific cost structure of Medicare Part A in 2025 helps you make better healthcare decisions when coordinating it with your PSHB plan.

Understanding What Medicare Part A Really Covers

Medicare Part A is often referred to as “hospital insurance,” and it plays a foundational role in your healthcare coverage once you are eligible. For PSHB enrollees who are retired postal workers, Medicare Part A can seem like a solid safety net—until you experience its fine print during a hospital stay.

In 2025, Medicare Part A covers:

• Inpatient hospital care

• Skilled nursing facility care (after a qualifying hospital stay)

• Hospice care

• Limited home health services

However, coverage does not mean everything is fully paid for. It is important to distinguish between what Medicare Part A covers versus what it leaves you responsible for.

Hospital Stays: Costs You Need to Know

When you are admitted to a hospital, Medicare Part A triggers certain cost responsibilities:

• Deductible: You must pay an inpatient hospital deductible of $1,676 for each benefit period.

• Coinsurance for extended stays:

  • Days 1-60: $0 coinsurance after deductible.

  • Days 61-90: $419 per day.

  • Days 91 and beyond: $838 per “lifetime reserve day” (you have up to 60 of these days over your lifetime).

  • After lifetime reserve days are used: All costs fall on you.

A “benefit period” starts when you are admitted as an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days. This means you could face multiple deductibles in a single year if you are hospitalized more than once with enough time between admissions.

Skilled Nursing Facility Care: The Additional Details

Medicare Part A provides some coverage for skilled nursing facility (SNF) care if you meet specific conditions, including a qualifying hospital stay of at least three consecutive days.

In 2025, your costs under Medicare Part A for SNF care are:

• Days 1-20: $0 coinsurance.

• Days 21-100: $209.50 per day.

• Day 101 and beyond: You pay all costs.

This limit makes it essential to plan beyond the initial 20-day window if ongoing skilled care is likely.

Home Health Care and Hospice Coverage Explained

Home Health Services

Medicare Part A covers limited home health services if medically necessary and ordered by a doctor. Generally, there are no out-of-pocket costs for covered home health services, though you may pay 20% of the Medicare-approved amount for durable medical equipment.

Hospice Care

For hospice care under Part A:

• You pay nothing for hospice services.

• You may need to pay a small copayment of up to $5 per prescription for pain relief and symptom control.

• Room and board are typically not covered if you receive hospice care in your home.

Key Timelines to Watch

• enrollment: Most people are automatically enrolled in Medicare Part A at age 65 if they already receive Social Security or Railroad Retirement Board benefits.

• Benefit Periods: Restart after a 60-day break from hospital or SNF care, creating new deductibles.

• Skilled Nursing Days: Coverage is capped at 100 days per benefit period for SNF stays.

Common Misunderstandings About Medicare Part A Costs

Many postal retirees expect Medicare Part A to be almost fully comprehensive. However, key misunderstandings persist:

• Multiple hospital stays can trigger multiple deductibles in the same year.

• Medicare Part A does not cover long-term custodial care.

• After exhausting lifetime reserve days, patients are responsible for 100% of costs.

• Skilled nursing facility care beyond 100 days per benefit period is entirely out-of-pocket.

How PSHB Can Help Cover the Gaps

In 2025, your PSHB plan may work with Medicare Part A to reduce or eliminate many of these out-of-pocket costs. Generally, PSHB plans coordinate benefits in the following ways:

• Cover hospital coinsurance after day 60.

• Pick up skilled nursing facility copayments after day 20.

• Provide additional coverage beyond Medicare’s limits.

• Reduce or eliminate copayments for hospice-related medications and equipment.

However, not all PSHB plans are identical. Reviewing the coordination of benefits for your specific plan ensures you understand what costs will still be your responsibility.

The Critical Role of Having Both Medicare Part A and PSHB

Combining Medicare Part A with your PSHB plan helps you in several ways:

• Lower out-of-pocket hospital costs.

• Greater financial protection against multiple benefit periods.

• More complete coverage for skilled nursing stays.

• Enhanced home health and hospice benefits.

If you rely on only one form of coverage, especially in a year where multiple hospital admissions occur, your out-of-pocket liability can escalate quickly.

Potential Pitfalls Without Proper Coordination

While Medicare Part A provides substantial coverage, gaps can create serious financial risks:

• A second hospital stay in a year could mean paying another $1,676 deductible.

• Extended hospitalizations after using lifetime reserve days could cost thousands of dollars.

• Skilled nursing facility care beyond 100 days becomes fully self-funded.

• Durable medical equipment costs, although modest, add up without supplemental support.

When PSHB coverage coordinates properly with Medicare, many of these risks are minimized. Failure to understand how your coverage works, however, can leave you with unexpected bills.

Planning Strategies for PSHB Members in 2025

If you are preparing for retirement or already retired under the PSHB system, proactive planning is critical.

• Review your PSHB plan’s Medicare coordination section annually.

• Confirm that your PSHB plan offers secondary coverage that pays after Medicare.

• Ensure both Medicare Parts A and B are in place to maximize PSHB benefits.

• Keep records of hospital admissions and benefit periods.

• Prepare for potential costs even with coverage.

Why the Hospital Bill Often Catches People Off Guard

Hospital bills under Medicare Part A surprise many people for one reason: the system operates based on benefit periods, not annual limits. You could easily think you are “covered” and still face:

• A new deductible later in the year.

• Daily coinsurance charges if your stay exceeds 60 days.

• High out-of-pocket costs once lifetime reserve days are exhausted.

Understanding these structural details can prevent you from mistakenly assuming a “one and done” deductible situation.

What Happens If You Delay or Skip Medicare Part A?

Most people qualify for premium-free Part A if they or their spouse paid Medicare taxes for at least 40 quarters. Delaying enrollment can create serious problems:

• If you’re not automatically enrolled at 65 and don’t sign up, you could face penalties.

• PSHB plans expect Medicare enrollment to coordinate benefits effectively.

• Skipping Medicare Part A means your PSHB plan becomes primary payer, which could increase your costs.

In short, if you’re eligible, enrolling in Medicare Part A on time is generally the most cost-effective decision.

Navigating Skilled Nursing Facility Coverage with Confidence

Hospital discharge planning often leads to skilled nursing facility stays. Make sure you know these points:

• Medicare requires a three-day inpatient hospital stay (not just “under observation”) to qualify.

• Days in a skilled nursing facility can quickly add up in costs after day 20.

• Without Medicare Part A, skilled nursing care is far more expensive.

Proper coordination between Medicare and PSHB means those transitions are more manageable, both medically and financially.

Staying Ahead of Hospital and Skilled Care Costs

In 2025, healthcare expenses continue to rise, and understanding how your coverage works is more important than ever. Whether you are still working at USPS or retired, becoming familiar with Medicare Part A’s hospital billing structure allows you to:

• Minimize financial shocks.

• Make better decisions about your care.

• Ensure your PSHB plan is supporting you in the ways you expect.

You don’t have to figure it out alone.

Understanding Your Options for Hospital Coverage Coordination

As a PSHB enrollee, coordinating Medicare Part A with your PSHB plan is key to maximizing your healthcare benefits. If you have questions about how your PSHB plan interacts with Medicare, or if you are unsure whether you are optimizing your coverage, now is the time to take action.

Speak with a licensed insurance agent listed on this website to review your options and get clear answers tailored to your unique situation.