Medicare Hospital Coverage (Part A)

Summary: Medicare Part A provides coverage for inpatient hospital care, hospice care, home health care, and care at skilled nursing facilities. Understanding which services are covered and which are not is essential for reducing your out-of-pocket healthcare expenses. Estimated Read Time: 8 min

Medicare Part A Covered Services

Medicare Part A, the hospital insurance portion of Medicare, covers inpatient benefits for beneficiaries. When you have Medicare Part A, you are responsible for paying your Medicare Part A deductible, copayments, and coinsurance when you utilize benefits. Below, we discuss what Medicare Part A covers and how to utilize your benefits.

Medicare Part A Covers:

• Inpatient hospital care
• Care at a skilled nursing facility
• Hospice care
• Home health care

When using your Medicare Part A benefits for care at a hospital or skilled nursing facility, it is essential to understand how benefit periods work. A benefit period begins the day you’re admitted as an inpatient and ends when you haven’t gotten any inpatient care for 60 consecutive days. You will start a new benefit period if admitted into a skilled nursing facility or hospital after your benefit period ends.

You must pay the Medicare Part A deductible each time you begin a new benefit period. There is no limit to how many benefit periods you can have. For 2024, your deductible per benefit period will be $1,632 ($1,600 in 2023).

Medicare Part A Hospital Inpatient Coverage

Medicare Part A covers up to 90 days of inpatient hospital services per benefit period and offers an additional 60 days in lifetime reserve. For Medicare to cover your hospital care, the following conditions must be met: the hospital must accept Medicare, and you must be admitted to the hospital after an official doctor’s order.

Medicare Part A will cover inpatient care at acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, psychiatric care in inpatient psychiatric facilities, and inpatient care for qualifying clinical research studies.

Medicare Part A Covers the Following Inpatient Hospital Services:

• Semi-private rooms
• Hospital meals
• General nursing care
• Drugs (including methadone to treat an opioid use disorder)
• Other hospital services and supplies as part of your treatment

Inpatient Hospital Services that Medicare Part A Does Not Cover:

• Private-duty nursing
• Private room (unless medically necessary)
• Television or phone in the room (if these items are charged separately)
• Personal care items such as slipper socks

Note about blood transfusions while an inpatient: If the hospital must buy blood for you, you must pay for the first three units of blood you get in a calendar year. (You or someone else can also choose to donate the blood. This may be a viable option if you have a procedure scheduled and donate ahead of time). If the blood is received from a blood bank at no change, you won’t have to pay for it or replace it.

You will be responsible for paying your Medicare Part A deductible during each benefit period. During the first 60 days you’re in a hospital, you will not pay any out-of-pocket costs outside of your deductible. Once you exceed 60 days, you must pay a coinsurance each day while you remain in inpatient care. If your hospital stay exceeds 90 days, you will begin using your lifetime reserve days. If you don’t have any lifetime reserve days left, you will be responsible for paying all costs once you exceed 90 days in inpatient care.

Each Medicare beneficiary has 60 lifetime reserve days they can use for inpatient care that exceeds 90 days.

When using your Medicare Part A benefits for inpatient care at a freestanding psychiatric hospital, you will only have coverage for 190 days during your lifetime.

Sometimes, it can be challenging to differentiate between inpatient and outpatient care, especially when receiving care at a hospital. For example, if you go to a hospital for emergency services, that is outpatient care. However, once you are formally admitted to the hospital due to a doctor’s order, your care going forward is inpatient care. When in doubt, you or your caregiver can ask the hospital or doctor whether you’re an inpatient or outpatient.

Medicare Part A Coverage for Skilled Nursing Facilities

For each benefit period, Medicare Part A will cover up to 100 days in a skilled nursing facility. A skilled nursing facility is a facility with the staff and equipment necessary to provide skilled nursing care, skilled rehabilitative services, and other related health services. For Medicare Part A to cover your stay at a skilled nursing facility, the following conditions must apply:

• You have had at least three days of a medically necessary inpatient hospital stay
• Your doctor certifies the need for daily skilled care
• You receive care at a Medicare-certified skilled nursing facility
• You need skilled services for a hospital-related medical condition or a condition that started while you were getting care at a skilled nursing facility for a hospital-related medical condition

For care at a skilled nursing facility, Medicare Part A covers:

• Semi-private rooms
• Meals
• Skilled nursing and therapy services
• Medications
• Medical supplies and equipment used in the facility
• Other medically necessary services needed to meet your health goal

For each benefit period, days 1-20 in a skilled nursing facility receive 100% coverage by Medicare Part A. For days 21-100, you are responsible for a $204 copayment each day, with Medicare Part A covering the rest. You must pay all costs if you exceed 100 days in a skilled nursing facility.

Medicare does not cover long-term care, such as personal care assistance at an assisted living facility or nursing home. Resources are available for those who need help with long-term care costs. Contact your State Health Insurance Assistance Program (SHIP) or your State Medical Assistance (Medicaid) Office for more information.

Hospice Care Covered by Medicare Part A

Medicare Part A will provide coverage for Medicare beneficiaries who are terminally ill. To receive Medicare hospice coverage, you must meet the following conditions:

• You have Medicare Part A
• Your hospice doctor and your regular doctor (if you have one) certify that you have a terminal illness and have an expected lifespan of 6 months or less
• You choose to receive comfort care (palliative care) instead of receiving care to cure your illness
• You sign a statement choosing to receive hospice care instead of other Medicare-covered treatments for your illness.

You must choose a Medicare-approved hospice provider when electing to use your Medicare hospice benefits. You can choose to have a one-time-only hospice consultation with a hospice medical director or hospice doctor to discuss care options and pain/symptom management. Though hospice care is generally provided in your home, you may receive care in a hospice inpatient facility, depending on your illness.

Medicare hospice care coverage includes:

• All services needed to relieve pain and manage symptoms
• Medical, nursing, counseling, and other social services
• Drugs and durable medical equipment required for pain relief and symptom management
• Aide and homemaker services
• Spiritual and grief counseling for you and your family
• Inpatient respite care

Medicare Part A provides coverage for respite care. Suppose your usual caregiver, such as a family member, needs rest. In that case, Medicare will cover up to 5 days for you to stay in a Medicare-approved facility (such as a hospice inpatient facility). Your hospice provider can help coordinate respite care for you and your caregiver.

Though you will not be required to pay a deductible, you will still have some out-of-pocket costs when using Medicare for hospice care. You will still need to pay your monthly premiums for Medicare Part B and Medicare Part A (if applicable). You will also be responsible for a copayment of up to $5 per prescription drug for pain and symptom management and up to 5% of the Medicare-approved amount for inpatient respite care.

Like inpatient hospital coverage, hospice care is provided within benefit periods. You’ll receive hospice care for two 90-day benefit periods followed by an unlimited number of 60-day benefit periods. After your first 90-day benefit period, your hospice doctor must recertify that you’re terminally ill for you to continue to receive your benefits. If you’re dissatisfied with your hospice provider, you can change providers once per benefit period.

You can choose to end your hospice care at any time. If your health improves or your illness goes into remission, you can contact your hospice provider to stop your hospice benefits.

Medicare Part A Coverage for Home Health Care

Medicare Part A provides coverage for home health care for individuals who meet specific eligibility criteria. Medicare will only cover services that are considered necessary for the treatment of your illness or injury. To receive coverage for home health care, your doctor or provider must certify that you are homebound and need health services at your home. You must also choose a home health agency that is Medicare-certified.

You may not qualify for home health care if you need full-time skilled nursing care over an extended period.

Medicare-covered home health services include:

• Medically necessary intermittent or part-time skilled nursing care
• Physical therapy, occupational therapy, or speech-language pathology services
• Medical social services
• Medical supplies for use at home

Medicare will also cover durable medical equipment for home health care; however, these will be billed separately and covered under your Medicare Part B.

Home health care services that Medicare does not cover include:

• 24-hour care at home
• Meals delivered to your home
• Care services like shopping, cleaning, and laundry
• Personal care such as bathing or dressing (when this is the only care you need)

If you’re unsure if certain services are covered, talk to your doctor or home health agency.

How to Get Coverage for Services Medicare Part A Doesn’t Cover

Medicare Part A provides extensive coverage for inpatient care. When combined with Medicare Part B, these two parts of Original Medicare create a solid foundation that meets the needs of many individuals. If you have healthcare needs that Original Medicare doesn’t cover, options are available to supplement your coverage.

Private insurance providers offer Medicare Supplement plans and Medicare Part D Prescription Drug plans and can be joined while maintaining your Original Medicare benefits. Medicare Advantage plans are also available for those who want to explore additional coverage options outside of Original Medicare.

Whether you have questions about your Medicare Part A coverage or costs, we’re here to help. Call us at the number above and our team of licensed insurance agents can answer your questions.

Sources

Inpatient Hospital Care, Medicare. Accessed September 2023

https://www.medicare.gov/coverage/inpatient-hospital-care

Skilled Nursing Facility (SNF) Coverage, Medicare. Accessed September 2023

https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care

Medicare & You 2024, Medicare. Accessed September 2023

https://www.medicare.gov/publications/10050-Medicare-and-You.pdf

Medicare Hospice Benefits, Centers for Medicare & Medicaid Services. Accessed September 2023

https://www.medicare.gov/Pubs/pdf/02154-medicare-hospice-benefits.pdf