What does Medicare Part A cover?

If you have questions about what services and supplies are covered by Medicare, start by having a conversation with your health care provider. You can also use the portal on the Medicare website to see if a service is covered.

Learn more at medicare.gov.

Events that are covered by Medicare Part A:

• Inpatient care in a hospital
• Skilled nursing facility care
• Nursing home care
• Hospice care
• Home health care – visit medicare.gov for the most up-to-date explanation of coverage

Note: Medicare doesn’t cover long-term care or custodial care.

Part A covered services explained

Hospital care (inpatient care)

Medicare covers semi-private rooms, meals, general nursing and drugs as part of your inpatient treatment. This includes care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and inpatient mental health care given in a psychiatric hospital or other hospital.

This does not include private duty nursing, a television or phone in your room (if there's a separate charge for these items), or personal care items, like razors or slipper socks. It also does not include a private room, unless medically necessary.

If you have Part B, it generally covers 80 percent of the Medicare-approved amount of doctor's services you get while you're in the hospital.

You pay:

• A deductible and no coinsurance for days 1-60 of each benefit period
• Coinsurance per day for days 61-90 of each benefit period
• Coinsurance per "lifetime reserve day" after day 90 of each benefit period (up to 60 days over your lifetime)
• All costs for each day after you use all the lifetime reserve days
• Inpatient psychiatric care in a freestanding psychiatric hospital is limited to 190 days in a lifetime

Staying overnight in a hospital doesn't always mean you're an inpatient. Your doctor must order your hospital admission and the hospital must formally admit you for you to be an inpatient. Without the formal inpatient admission, you're still an outpatient, even if you stay overnight in a regular hospital bed, and/or you're getting emergency department services, observation services, outpatient surgery, lab tests or X-rays.

Skilled nursing facility care

Medicare covers semi-private rooms, meals, skilled nursing and rehabilitative services, and other medically necessary services and supplies furnished in a skilled nursing facility after a three-day minimum, medically necessary, inpatient hospital stay for a related illness or injury.

An inpatient hospital stay begins the day the hospital formally admits you as an inpatient based on a doctor’s order and doesn’t include the day you’re discharged. You may get coverage of skilled nursing care or skilled therapy care if it’s necessary to help improve or maintain your current condition.

To qualify for skilled nursing facility care coverage, your doctor must certify that you need daily skilled care (like intravenous injections or physical therapy) which, as a practical matter, can only be provided in a skilled nursing facility if you’re an inpatient.

You pay:

• Nothing for the first 20 days of each benefit period
• Coinsurance per day for days 21-100 of each benefit period
• All costs for each day after day 100 in a benefit period – visit medicare.gov for the most up-to-date explanation of coverage

Note: Medicare does not cover long-term care or custodial care.

Hospice care

To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of six months or less. You must accept palliative care (for comfort) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Coverage includes:

• All items and services needed for pain relief and symptom management
• Medical, nursing and social services
• Drugs
• Certain durable medical equipment
• Aide and homemaker services
• Other covered services, as well as services Medicare usually doesn’t cover, like spiritual and grief counseling

A Medicare-certified hospice usually gives hospice care in your home or the facility where you live, like a nursing home.

Hospice care doesn’t pay for your stay in a facility (room and board) unless the hospice medical team determines that you need short-term inpatient stays for pain and symptom management that can’t be addressed at home.

These stays must be in a Medicare-approved facility, like a hospice facility, hospital or skilled nursing facility that contracts with the hospice.

Medicare also covers inpatient respite care, which is care you get in a Medicare approved facility so that your usual caregiver (family member or friend) can rest. You can stay up to five days each time you get respite care. Medicare will pay for covered services for health problems that aren’t related to your terminal illness or related conditions.

After six months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re terminally ill.

You pay:

• Nothing for hospice care
• A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management
• 5% of the Medicare-approved amount for inpatient respite care

Home health services

You can use your home health benefits under Part A and/or Part B. 

Medicare coverage is based on three main factors

• Federal and state laws
• National coverage decisions made by Medicare about whether a service is covered
• Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether a service is medically necessary and should be covered in their area.

Source: Medicare.gov