Medicare Part A (hospital coverage) is the first component of a multi-part health insurance system. It provides people ages 65 and up, and people with certain disabilities, with hospitalization and other inpatient care coverage.
Medicare Part A works with Medicare Part B (medical coverage) and Medicare Part D (prescription coverage) to provide most of the major health benefits people need. Together, Part A and Part B are commonly known as Original Medicare.
To get additional coverage with Original Medicare, you can purchase a Medigap policy (Medicare Supplement). Part C, more commonly called Medicare Advantage, is a private insurance alternative to Original Medicare.
NOTE: If you’re in a Medicare Advantage Plan or a Special Needs Plan your plan may have different rules. However, your plan must provide the same basic inpatient coverage as Medicare Part A. With private health plans, some services may only be covered in certain facilities or for people with certain conditions.
Medicare Part A generally covers:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (except long-term care)
- Home health care
- Hospice care (at home or in a facility)
Medicare Part A coverage is based on 3 main factors:
- State and Federal laws.
- National coverage decisions made by Medicare.
- State and local coverage decisions made by companies that process claims for Medicare to determine if a service is medically necessary.
If you are unsure whether certain services or supplies are covered, talk to your doctor. Ask if Medicare will cover the services or supplies you need. If you need something that’s usually covered but your provider thinks that Medicare won’t cover it in your situation, you will need to read and sign a Medicare notice. The notice lets you know that you may have to pay for the item, service, or supply.
Inpatient hospital care
Medicare Section A (Hospital Insurance). provides inpatient hospital care for those who meet these conditions:
- After an official doctor’s orders, you are admitted to the hospital as an Inpatient. This means that you require inpatient hospital care for your injury or illness; and
- The hospital facility accepts Medicare.
If the hospital’s Utilization Review Committee approves your stay while you are admitted, Medicare Part A will typically cover your inpatient hospital care.
Your Hospitalization Costs Under Medicare Part A
Medicare Part A measures your use of hospitalization and skilled nursing facility (SNF) services. The day you are admitted to a hospital or SNF as an inpatient, a benefit period begins. You lose your benefit period if you don’t receive any inpatient hospital or skilled care in an SNF for at least 60 consecutive days. A new benefit period starts if you enter a hospital or SNF after the previous benefit period ends. For each benefit period, you must pay the Medicare Part A deductible. There is no limit on the number of benefit periods or the number of times you can be charged the deductible.
In 2023 you pay this for each benefit period:
- $1,600 deductible
- Days 1–60: $0 coinsurance
- Days 61–90: $400 coinsurance per day
- Days 91 and beyond: $400 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Each day after lifetime reserve days : All costs
NOTE: To help you make informed decisions about your healthcare, hospitals must now make available the standard charges they charge for all items and services. This includes the negotiated costs by Medicare Advantage Plans.
Medicare-covered inpatient hospital services include:
- Semi-private rooms
- Meals
- General nursing care
- Drugs (including methadone to treat an opioid use disorder)
- Other hospital services and supplies as part of your inpatient treatment
Medicare Part A doesn’t cover:
- Private-duty nursing
- Private room (unless medically necessary)
- Television or phone in your room (if there’s a separate charge for these items)
- Personal care items
Inpatient hospital care includes care you get in:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Inpatient psychiatric facilities
- Long-term care hospitals
Lifetime inpatient mental health care in a psychiatric hospital is limited to 190 days.
NOTE: Medicare Part A does not cover inpatient doctor services. If you also have Medicare Part B, it covers approximately 80% of the Medicare-approved amount you pay for doctor’s visits while you are in inpatient care.
Skilled Nursing Facility Care Coverage and Costs
Skilled nursing care is therapy care performed by, or under the supervision of, medical professionals. It’s provided when you need skilled nursing or therapy to treat, manage, and observe your condition.
Medicare Part A covers skilled nursing care on a short-term basis when all of these conditions apply:
- You have Part A and have days left in your benefit period to use.
- You have a qualifying inpatient hospital stay
- Your doctor has decided that you need daily skilled care.
- You get skilled services in a Medicare-certified SNF.
- You need these skilled services for a medical condition that’s either a.) a hospital-related medical condition treated during your qualifying 3-day inpatient hospital, or b.) a condition that started while you were getting care in the SNF for a hospital-related medical condition.
In 2023 you pay this for each benefit period:
- Days 1–20: $0 coinsurance per day
- Days 21–100: Up to $200 coinsurance per day
- Days 101 and beyond: All costs
Medicare-covered services in a skilled nursing facility include:
- A semi-private room (a room you share with other patients)
- Meals
- Skilled nursing care
- Physical therapy (as required)
- Occupational therapy (as required)
- Speech-language pathology services (as required)
- Medical social services
- Medications
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation could endanger your health) for services not available at the SNF
- Dietary counseling
Home Health Care Coverage and Costs
Home health care is a variety of services that can be provided in your home to treat an injury or illness. Home health care is often less costly, easier, and as effective as the care you receive in a hospital (SNF).
Medicare Part A covers eligible home health services, after an inpatient hospital stay, including:
- Part-time or “intermittent” skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide care (only if you’re also getting other skilled services like nursing and/or therapy at the same time)
- Injectable osteoporosis drugs for women
- Durable medical equipment
- Medical supplies for use at home
Medicare Part A does not cover:
- 24-hour-a-day care at your home
- Meals delivered to your home
- Homemaker services that are not related to your care plan
- Custodial or personal care that helps you with daily living activities (if it is the only care you need)
Who’s eligible for Home Health Care?
Anyone with Part A and/or Part B who meets all of these conditions is covered:
- You are under a doctor’s care and are getting services under a plan of care created by a doctor.
- You must need, and a doctor must certify that you need, one or more of these:
- Intermittent skilled nursing care.
- Physical therapy, speech-language pathology, or continued occupational therapy services.
- You must be homebound, and a doctor must certify that you are homebound.
You are not eligible for the home health benefit if you need more than part-time or skilled nursing care.
Home Health Care Costs
- $0 for covered home health care services.
- After you meet the Part B deductible, 20% of the Medicare-Approved Amount for Medicare-covered medical equipment.
NOTE: Your home health agency must inform you of all Medicare costs before you begin receiving care. You should also be informed by the agency about any of the services or items they provide not covered by Medicare and how much you will have to pay. These should be discussed with you in person as well as in writing (Advance Beneficiary Notice or ABN).
Long-term Care Hospital Costs and Services
A long-term care hospital is an acute care facility that provides treatment for patients who stay, on average, more than 25 days. Most patients are transferred from an intensive or critical care unit. Services provided include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.
In 2023 you pay this for each benefit period in a long-term care hospital:
- $1,600 deductible
- Days 1–60: $0 coinsurance
- Days 61–90: $400 coinsurance per day
- Days 91 and beyond: $400 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Each day after lifetime reserve days : All costs
NOTE: You are not required to pay a deductible for care received in a long-term care hospital if you were already charged a deductible for care received for inpatient care within the same benefit period. Your benefit period starts on the first day of your prior hospital stay, and that stay counts towards your benefit period deductible.
Hospice Care Costs and Services
If you have Medicare Part A (Hospital Insurance), and all these conditions are met, then you may be eligible for hospice care:
- Your hospice doctor and your primary care doctor certify that you’re terminally ill (with a life expectancy of 6 months or less).
- You accept comfort care (palliative care) instead of care to cure your illness.
- You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.
Medicare-certified hospice care can be provided in your home, or at another facility such as a nursing home. Inpatient hospice facilities are also available. Medicare Part A will pay for your covered benefits for any conditions that are not related to your terminal illness or other conditions. However, this is rare. Your hospice benefit usually covers everything once you have chosen hospice care.
Your costs with Medicare Part A:
- You pay nothing for hospice care.
- You pay a copayment of up to $5 for each prescription for outpatient drugs for pain and symptom management.
- You may pay 5% of the Medicare-Approved Amount for inpatient respite care.
- You may have to pay for room and board if you live in a nursing home facility and choose to get hospice care.
Your hospice team will develop a plan of care based on your terminal illness or related conditions:
- Doctors’ services.
- Nursing and medical services.
- Durable medical equipment for pain relief and symptom management.
- Medical supplies, like bandages or catheters.
- Drugs for pain management.
- Aide and homemaker services.
- Physical therapy services.
- Occupational therapy services.
- Speech-language pathology services.
- Social services.
- Dietary counseling.
- Spiritual and grief counseling for you and your family.
- Short-term inpatient care for pain and symptom management.
- Inpatient respite care.
- Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness.
NOTE: Only your primary care doctor and your hospice doctor can confirm that you are terminally ill with a minimum life expectancy of six months. You can still receive hospice care after 6 months if your hospice doctor recertifies (at face-to-face meetings) that you are still terminally ill.
If you have a Medicare Advantage Plan and want to start hospice care, ask your plan to help you locate a hospice care provider in your area.