Medicare Part A is also known as hospital insurance.
Note – Keep in mind that if you have a Medicare Advantage Plan or another Medicare plan, this may differ; however, your plan has to give you the same coverage you'd get if you have Original Medicare.
In some cases, your policy may not cover some services.
In general, Part A covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care.
- Hospice care
- Home health care
Here are two ways to find out if Medicare covers the service you need.
1.) Ask your doctor about the services you need and if Medicare will cover them. They may ask you to sign a notice that you may have to pay out-of-pocket for the item or service.
2.) Check out this list to see if it's covered.
Medicare Part A coverage is based on these three factors.
1.) Federal and state laws
2.) National coverage decisions made by Medicare about what is covered.
3.) Local coverage decisions are made by companies in every state that process claims for Medicare. These companies can decide if something is medically necessary and if they'll cover it in their geographic area.
When Does Medicare Part A Cover Inpatient Hospital care?
- When you get admitted to the hospital after getting a referral from your doctor stating that you need inpatient hospital care for treatment.
- The hospital must accept Medicare.
- Sometimes the hospital will have programs that allow you to stay while you're at their hospital.
Medicare and Coronavirus
Note: Medicare covers the Covid-19 vaccine with no out-of-pocket costs. Just be sure to bring your Medicare card.
Suppose you have Medicare and, due to a disability or another challenge, cannot make it to a vaccination site. In that case, Medicare will pay a doctor or another provider to give you to Covid-19 vaccine at your home. You may have to provide your Medicare number for billing, but it's fully covered. Get details about getting the vaccine at home.
How Much Does Medicare Part A Cost?
Note – Keep in mind that your doctor may recommend that you get services more often than Medicare will cover them or recommend services that Medicare doesn't cover at all. When the happens, you'll have to pay out-of-pocket for all or some of the costs.
You should ask questions to understand why the doctor recommends the services thoroughly and if Medicare will cover them.
You'll pay this:
- $1,484 deductible for each benefit period.
- Days 1-60: $0 coinsurance for each benefit period.
- Days 61-90: $371 coinsurance per day for each benefit period
- Days 91 and beyond: $742 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days: all costs.
What's Does Part A Cover?
Medicare covers these services:
- Semi-private rooms
- General nursing
- Prescriptions as part of your inpatient treatment (including methadone to treat opioid use disorder.
- Other hospital services and supplies that you need for inpatient treatment.
Important things to know.
Inpatient mental health care in a psychiatric hospital is limited to 190 days in your life.
Inpatient hospital care includes the care you get in:
- Long-term care hospitals
- Critical access hospitals
- Inpatient rehab facilities
- Acute care hospitals
- Inpatient care as part of a qualified clinical research study.
Combined with Medicare Part B generally covers 80% of the amount that Medicare approves for doctor's services that you get when you're at the hospital.
Private duty nursing, private rooms (unless medically needed), television and phone in your room (if there is a separate charge for these items), and personal care items like razors or slipper socks.
How Does Medicare Part A Cover Skilled Nursing Facility (SNF) Care?
Medicare Part A covers skilled nursing care and, in some cases, for a limited time (on a short-term basis) if you meet certain conditions: If you have Part A but have no days left in your benefit period to use and have a qualified hospital stay.
If your doctor has decided that you need daily skilled care, it must be given by or under the supervision of a skilled nursing professional or therapy staff.
You also need to get these skilled nursing services in an SNF that's Medicare-certified.
Suppose you need these skilled nursing services for a medical condition. In that case, it has to be a hospital-related medical condition that can be treated during a 3-day qualified inpatient hospital stay, even if it's for a different reason than the one that got you admitted to the hospital.
Part A covers you for a condition that starts while getting care in the skilled nursing facility for a hospital-related medical condition. For example, if you develop an infection requiring IV antibiotics while getting SNF care.
How much does Skilled Nursing Care Cost in Original Medicare?
- Days 1-20 $0 for each benefit period.
- Days 21-100: $185.50 coinsurance per day for each benefit period
- Days 101 and beyond: all costs
What is Skilled Nursing Care?
Skilled care is nursing and therapy care performed by or supervised by highly trained and professional personnel.
Medicare will cover some of these services like:
Semi-private room (you have to share with other patients)
- Physical therapy (if needed)
- Occupational therapy (if required)
- Speech-language therapy
- Medical social services
- Medical supplies and equipment used in the facility
- Ambulance transportation (when necessary to the nearest location of services)
- Dietary counseling
- Swing bed services
- Skilled nursing care
How Does Medicare Part A Cover Long-term Hospital Services?
Medicare will cover the cost if you need to be in the hospital for the long term.
How much does it cost for long-term hospital care with Medicare Part A?
- Days 1-60: $1,484 deductible
- Days 61-90: $371 coinsurance each day
- Days 91 and beyond: $742 coinsurance per each “lifetime reserve day.” After day 90 for each benefit period (up to 60 days over your lifetime.,
You won't have to pay a deductible for the care you get in a long-term care hospital if you already paid a deductible for the care you received in a prior hospitalization in the same benefit period. Instead, your benefits start on day one of your last hospital stay, and that stay counts towards your deductible.
As an example:
- You get transferred to a long-term care hospital directly from an acute care hospital.
- You get admitted to a long-term care hospital within 60days of being discharged from a hospital.
What is a Long-term Care Hospital?
Long-term hospitals specialize in treating patients for more than 25 days. Some of these patients include people on a ventilator for an extended time or who have a head accident.
After being discharged from a long-term care hospital, most people end up getting care in a skilled nursing facility or custodial care in a long-term care facility.
Note: During the Covid-19 pandemic, you may be able to renew your SNF coverage without needing to start a new benefit period.
If you can't be in your home during Covid-19 or affected by the pandemic, you can get SNF care without a qualifying hospital stay.