Logan Reid
Medicare Part A is hospital insurance that covers inpatient hospital care, including surgeries, bloodwork, diagnostics, and hospital stays. It also covers hospice care and limited skilled nursing facility and home health services. After paying the deductible, Medicare covers the full cost of covered hospital services for the first 60 days of each benefit period. For longer stays, patients are responsible for paying a portion of the costs. Medicare Part A is part of Original Medicare, which is provided by the federal government and is available to US citizens aged 65 and older.
| Characteristics | Values |
|---|---|
| Type | Hospital insurance |
| Coverage | Inpatient hospital care, inpatient surgeries, bloodwork, diagnostics, hospice care, skilled nursing facility, home health services, mental health, nursing home care |
| Coinsurance | $400 per day for days 61-90 in 2023, $408 in 2024, $800 per day for lifetime reserve days in 2023, $816 in 2024 |
| Deductible | $1,600 in 2023, $1,632 in 2024, $1,676 in 2025 |
| Supplemental coverage | Medicare Supplement Insurance (Medigap), Medicare Advantage Plan |
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What You'll Learn
Inpatient hospital care
Medicare Part A covers inpatient hospital care when you are formally admitted. Part A, also known as hospital insurance, covers medically necessary inpatient hospital care, skilled nursing facility (SNF) care, home health care, and hospice care.
A benefit period begins the day you are admitted to a hospital as an inpatient and ends the day you have been out of the hospital or SNF for 60 days in a row. With each new benefit period, you pay a new deductible. Your coinsurance is determined by the number of days you have been in the facility during each benefit period. After day 60, you will pay a daily hospital coinsurance. The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment.
Part A covers inpatient stays in hospitals, critical access hospitals, and skilled nursing facilities. It also covers hospice care and some home care. If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctors’ services you get while you’re in a hospital.
Medicare-covered inpatient hospital services include inpatient care you get as part of a qualifying clinical research study. It is important to note that Medicare does not cover private duty nursing. A private room is also not covered unless it is medically necessary or if it is the only room available.
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Hospice care
Medicare Part A covers inpatient hospital care, skilled nursing facility care, some home care, and hospice care. Hospice care is a comprehensive program of care and support for terminally ill patients and their families. It includes pain and symptom management, as well as emotional and spiritual support for the patient and their loved ones.
To qualify for hospice care under Medicare Part A, a patient's hospice doctor and regular doctor must certify that the patient is terminally ill, with a life expectancy of six months or fewer. The patient must also accept comfort care (palliative care) instead of treatment to cure their illness. Once qualified, patients can receive hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods. Hospice care can be provided at home, in a nursing home, or in an inpatient hospice facility.
Medicare pays hospice agencies a daily rate for each day a patient is enrolled, regardless of the number of services provided. This daily payment covers the costs of providing services included in the patient's care plan, such as nursing care, physician services, and counseling. Patients may owe a coinsurance payment of up to 5% of the cost of drugs or biologicals, with a maximum copay of $5 per prescription. However, during inpatient respite care, patients do not owe any coinsurance.
It is important to note that Medicare Part A does not cover personal items, such as razors or socks, unless provided to all patients at no additional charge. Additionally, physicians' fees in the hospital are typically covered under Medicare Part B. Patients should also be aware that if they choose to leave hospice care, their plan will restart the first day of the following month.
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Skilled nursing facility
Medicare Part A covers skilled nursing facility (SNF) care for a limited time (on a short-term basis) if certain conditions are met. Firstly, you must have Medicare Part A with days left in your benefit period to use. Secondly, you must have a qualifying inpatient hospital stay of at least three days, during which you are treated for an illness or injury that requires a hospital stay, such as a fall, stroke, or surgery. Thirdly, you must enter the SNF within 30 days of leaving the hospital, and a doctor or healthcare provider must determine that you need daily skilled care, such as intravenous fluids, medications, or physical therapy. This care must be received from or under the supervision of skilled nursing or therapy staff in a Medicare-certified SNF.
Medicare covers up to 100 days of care in a SNF for each benefit period, paying 100% for the first 20 days. From days 21 to 100, there is a copayment of $209.50 per day, which may be covered by Medicare Advantage Plans or other programs like Medicaid or Veterans' benefits. If you require ongoing or long-term care in a SNF, you will need to pay out of pocket or use alternative funding sources.
Medicare provides an online tool to help identify approved SNFs, and case managers and social workers can assist with coverage for SNF stays. It is important to confirm that the SNF is certified to provide Medicare-covered care and meets your specific needs. Additionally, there may be situations where you need to be readmitted to the hospital during your SNF stay, and it is advisable to clarify the availability of a bed upon your return.
In summary, Medicare Part A provides coverage for short-term stays in skilled nursing facilities under specific conditions, with a maximum of 100 days of care per benefit period.
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Home health services
Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. While home health care is typically covered by Medicare Part B, Part A provides coverage in certain circumstances.
To be eligible for home health care under Medicare Part A, you must meet specific criteria. Firstly, you must have spent at least three consecutive days as a hospital inpatient, formally admitted by a doctor. Secondly, you must meet the home health care eligibility requirements, such as being "homebound" and requiring skilled care. Being "homebound" means having difficulty leaving your home without assistance due to an illness or injury. It also includes situations where leaving your home is not recommended or feasible due to your medical condition.
Under Medicare Part A, you are entitled to up to 100 days of home health care coverage after a qualifying hospital or skilled nursing facility stay. This coverage includes part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, and occupational therapy. A healthcare provider, such as a nurse practitioner, must assess you in person and certify that you require home health services. Additionally, a Medicare-certified home health agency must provide the services, and they are responsible for informing you about the costs covered by Medicare.
It is important to note that Medicare Part A has specific requirements for home health care coverage. The services must be medically necessary and meet Medicare's requirements. Additionally, you may be subject to a pre-claim review process, depending on your location, to determine whether Medicare will cover the services.
Medicare Part A covers the full cost of covered hospital services for the first 60 days of each benefit period. A benefit period begins on the day you are admitted to the hospital as an inpatient and ends after you have been out of the hospital for 60 consecutive days. For each day beyond the first 60 days, you will be responsible for a portion of the cost, known as coinsurance. The specific costs and deductibles may vary from year to year, so it is essential to refer to the most current information available.
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Lifetime reserve days
Medicare Part A covers inpatient stays in hospitals, critical access hospitals, and skilled nursing facilities, as well as some home care and end-of-life hospice care. It also covers inpatient care as part of a qualifying clinical research study. After paying the Part A deductible, Medicare pays the full cost of covered hospital services for the first 60 days of each benefit period. A benefit period begins when you are admitted to a hospital as an inpatient and ends after you have been out of the hospital or skilled nursing facility for 60 consecutive days.
For days 61 to 90, you pay $419 per day. After day 90, if you opt to use your lifetime reserve days, you pay $838 for each day up to your 60-day limit of lifetime reserve days. You can notify the hospital that you do not want to use your lifetime reserve days, but you will be required to pay for the full cost of your care for those days. You may find it beneficial to delay using your lifetime reserve days and pay the hospital's daily charge instead, especially if your hospital costs are only slightly higher than the coinsurance for lifetime reserve days. In such cases, you may want to save your lifetime reserve days for future hospital stays that may be more expensive.
You can purchase a Medicare Supplement policy, also known as Medigap, to help cover the Part A deductible and hospital coinsurance, as well as provide additional lifetime reserve days. All Medigap plans (A through L) pay for hospital coinsurance and provide up to 365 additional lifetime reserve days. Medicare Supplement insurance is available to individuals aged 65 and older enrolled in Medicare Parts A and B, and in some states, to those under 65 who are eligible for Medicare due to disability or end-stage renal disease.
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Frequently asked questions
Medicare Part A covers inpatient hospital care, including surgeries, bloodwork, diagnostics, and hospital stays. It also covers hospice care, skilled nursing facility care, and some home health services.
After paying the Part A deductible, Medicare covers the full cost of covered hospital services for the first 60 days of each benefit period. For days 61 to 90, there is a daily coinsurance cost of $400 in 2023, rising to $408 in 2024 and $419 in 2025. After 90 days, you can use lifetime reserve days (up to 60 days) at a higher cost of $800 per day in 2023, $816 in 2024, and $838 in 2025.
You are considered an inpatient when formally admitted to the hospital by a doctor's order, typically requiring a stay through two midnights. Observation stays are often classified as outpatient care, which is covered by Medicare Part B.
