What makes a hospital a Critical Access Hospital
Critical Access Hospital is a federal designation under 42 CFR Part 485, Subpart F. To qualify, a hospital generally must:
- be in a rural area, or be treated as rural;
- be more than a 35-mile drive from another hospital, or 15 miles in mountainous terrain or where only secondary roads exist (some older "necessary provider" designations are grandfathered);
- keep no more than 25 inpatient beds, which can also be used as swing beds;
- keep acute inpatient stays to an annual average of 96 hours or less;
- offer emergency services 24 hours a day.
The 15-mile mountain rule matters in western North Carolina, where winding roads make short distances long drives.
North Carolina's 20 Critical Access Hospitals
CMS's Hospital General Information file, released November 12, 2026, lists 20 in 19 counties:
| Region | Towns (county) |
|---|---|
| Mountains | Bryson City (Swain), Murphy (Cherokee), Franklin and Highlands (Macon), Brevard (Transylvania), Columbus (Polk), Spruce Pine (Mitchell), Linville (Avery), Jefferson (Ashe), Sparta (Alleghany) |
| Piedmont | Danbury (Stokes), Siler City (Chatham), Troy (Montgomery) |
| East and coast | Windsor (Bertie), Edenton (Chowan), Plymouth (Washington), Nags Head (Dare), Elizabethtown (Bladen), Burgaw (Pender), Southport (Brunswick) |
North Carolina has no Rural Emergency Hospitals, the newer type with no inpatient beds. Listing is not an endorsement.
How Medicare works there
Medicare covers care at a Critical Access Hospital the same way it covers care at other hospitals. Part A covers inpatient stays and swing-bed skilled nursing care after a qualifying stay; Part B covers the emergency department, lab work, imaging and other outpatient services. Your usual deductibles and coinsurance apply; current amounts are on Medicare costs in 2026. A Medigap policy helps with them, and Original Medicare works at every Critical Access Hospital that accepts Medicare.
With a Medicare Advantage plan, check whether your local Critical Access Hospital is in network for non-emergency care such as lab work, imaging or a swing-bed stay. Emergency care is covered in or out of network.
If your nearest hospital is a Critical Access Hospital
- Use it in an emergency. Call 911 or go to the nearest emergency department.
- Ask where it transfers patients for surgery, cardiac or stroke care, and check that hospital against your plan's network.
- Ask about outpatient services close to home, such as lab, imaging, therapy and swing-bed recovery.
More in Medicare in rural and mountain North Carolina. To compare plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
What is a Rural Emergency Hospital?
Why North Carolina has none yet.
Does Medicare pay for air ambulance?
Transfers to larger hospitals.
Does Medicare cover telehealth in rural NC?
Visits from home through 2027.
Sources
- CMS — Hospital General Information (released November 12, 2026)
- eCFR — 42 CFR Part 485, Subpart F, Critical Access Hospitals (sections 485.610, 485.618, 485.620)
- CMS — Critical Access Hospitals
More questions in this guide
- Does Medicare cover telehealth in rural North Carolina?
- Does Medicare pay for air ambulance in North Carolina?
- What is a Rural Emergency Hospital in North Carolina?
- What Medicare options are there in the North Carolina mountains?
Part of the guide: Medicare in Rural and Mountain North Carolina · All questions
Frequently asked questions
Does Medicare cover a stay at a Critical Access Hospital?
Yes. Part A covers inpatient care there, and Part B covers emergency and outpatient services, with the usual deductibles and coinsurance. Medicare Advantage plans cover it too if the hospital is in network, and emergency care is covered in or out of network.
What is a swing bed?
Critical Access Hospitals can use their inpatient beds either for hospital care or as swing beds for skilled nursing care after a hospital stay (42 CFR 485.620). That can let you recover close to home instead of at a distant nursing facility.
Will a Critical Access Hospital transfer me?
Often, for care it doesn't provide. Its inpatient stays average 96 hours or less, so patients who need surgery or intensive care are usually moved to a larger hospital, sometimes by helicopter.
Medicare in your North Carolina county
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