Medicare Part A:
What to Know about Hospital Insurance Coverage
Medicare is a federal health insurance program offered to people 65 years of age and older and younger people with certain disabilities and illnesses. Medicare has four different parts. Part A offers coverage for hospitalizations.
You may get your inpatient care at a hospital, a critical access hospital, an inpatient mental healthcare hospital or an inpatient rehabilitation facility.
What Does Medicare Part A Cover?
Medicare Part A is hospital insurance. It covers the hospital charges and certain expenses you have during a hospital stay, including meals, operating room fees, necessary medical supplies and lab tests. Medicare Part A also covers inpatient hospital care required as part of a clinical research study.
However, Medicare Part A doesn’t cover doctor fees while you’re hospitalized—these are covered under Medicare Part B. Medicare Part A benefits also don’t extend to medically unnecessary fees, such as private duty nursing or personal care items.
When you’re admitted to a hospital, Medicare Part A covers most of your costs for up to 60 days. You’re responsible for paying a benefit period deductible. This period begins the day you are admitted and ends when you have been out for 60 days in a row.
Covered inpatient hospital services include:
- Semi-private rooms
- All meals, including special or medically-necessary diets
- Skilled nursing services
- Care received in a special unit, such as Intensive Care and Coronary Care
- Drugs, medical supplies and medical equipment used during your inpatient stay
- Lab tests and X-rays completed during your inpatient stay
- Operating room and recovery room services
- Rehabilitation services received during your inpatient stay
- Some blood transfusions
Skilled nursing facility care
Skilled nursing facility stays are covered under Medicare Part A following a related inpatient hospital stay. To qualify for skilled nursing facility care, your hospital stay must have lasted at least three days and occurred within the 30 days prior to skilled nursing facility admission.
Medicare Part A covers a semi-private room, meals and a range of services provided by the skilled nursing facility, including rehabilitation services, medications and medication administration, tube feedings, wound care and dietary counseling.
Home healthcare services
Medicare Part A covers home health care services when deemed medically necessary and ordered by your healthcare provider. These services include part-time or intermittent care, including physical therapy, speech-language pathology, occupational therapy, home health aide services and medical social services. Medicare Part A covers the entire cost of home healthcare services.
However, if your doctor orders durable medical equipment for your use at home, this is covered under Medicare Part B. You are responsible for 20% of the Medicare-approved amount.
If your healthcare provider has determined that you are terminally ill (six months or less to live), you qualify for hospice care through Medicare Part A. This palliative care focuses on relieving pain and keeping you as comfortable as possible. You are covered to receive hospice care as long as you need it. These services are typically provided in your home.
Hospice services covered under Medicare Part A include:
- Doctor services and nursing care
- Pain relief medications
- Social services
- Durable medical equipment and medical supplies
- Hospice aide services
- Homemaker services
- Physical therapy
- Occupational therapy
- Dietary counseling
- Short-term inpatient care, if required for pain or symptom management
To receive hospice care through Medicare Part A, you must agree to stop curative treatments. However, you have the right to stop hospice care and restart curative treatments at any time.
How Much Does Medicare Part A Cost?
Is Medicare Part A free?
Well, not exactly. Most beneficiaries will pay nothing for Medicare Part A at age 65 though because they have already pre-paid it. You see, we all pay taxes during our working years that are specifically for our future Medicare hospital coverage during retirement.
When you’re hospitalized, Medicare Part A pays most of the costs for stays of up to 60 days. You will still be responsible for the benefit period deductible. A benefit period begins the day you are admitted into a hospital or skilled nursing facility and ends when you have been out for 60 days in a row. You may have multiple hospital stays during one benefit period.