What Does Medicare Part A Cover?
What Medicare Part A covers is inpatient hospital care. You can think of Part A as your hospital “room and board". It can cover a semi-private hospital room with a bed, three meals per day, and the nurse that comes around to visit you. Medicare Part A benefits include medications given to you by the hospital and any necessary lab services or medical supplies. However, before Medicare Part A can pay anything, you must first pay Part A deductible, which is $1,600 for 2023.
Medicare Part A: Hospital Coverage
Inpatient hospital care is covered by Medicare Part A when: 0
1. You are admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
AND
2. The hospital accepts Medicare.
In certain cases, the Utilization Review Committee of the hospital approves your stay while you are in the hospital.
Before Medicare Part A Pays Anything, You Must First Pay Part A Deductible $1,600 In 2023.
Medicare Part A: Hospital Coverage
According to CMS, 0 the Part A inpatient hospital deductible can cover your cost for the first 60 days of Medicare-covered inpatient hospital care. For example, you become an inpatient at a hospital on Jan. 1. Happy New Year, you pay the Part A deductible. The next day your doctor discharges you. After 60 consecutive days you have not been admitted as an inpatient. Then on April 1, you get injured and become an inpatient again. Now, you will need to pay the Part A deductible again.
What Does Medicare Part A Cover?
Some of what Medicare Part A does cover may include:
Inpatient care in a hospital
Inpatient care in skilled nursing facility (SNF)
Hospice care
Home health care
You may receive Medicare services from the following inpatient facilities:
Acute care hospitals
Critical access hospitals
Long-term care hospitals
Inpatient care as part of qualifying clinical research study
Mental health care
Long-Term Care Hospital (LTCH) Care
After you have paid your Part A deductible of $1,600 in 2023, Part A pays for long-term care in a LTCH for the first 60 days of hospitalization. However, between 61 days and 90 days, you pay $400 co-insurance. After 90 days, you pay $800 co-insurance per each “lifetime reserve day” in 2023. After being discharged from an LTCH, many people receive care in a skilled nursing facility or custodial care in a long-term care facility.
Skilled Nursing Facility (SNF) Care
Medicare Part A does cover skilled nursing care by a SNF under certain conditions and for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by or under the supervision of professionals. It is health care given when you need skilled nursing or skilled therapy to treat, manage, or observe your condition and evaluate your care.
What Does Skilled Nursing Care Cost?
Medicare Part A does cover up to 20 days of skilled nursing or therapy staff. However, you pay up to $200 co-insurance per day for days 21 to 100 in 2023. Then you pay all costs beyond 100 days.
What Can Be Covered in a Skilled Nursing Facility?
Semi-private room (a room you share with other patients)
Meals
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Medications
Ambulance transportation
Hospice Care
Medicare Part A 0 can pay for your hospice care. However, you may need to pay a co-payment of no more than $5 for each prescription drug. For example, drugs for pain relief and symptom control while you are at home. Furthermore, you may need to pay 5% of the Medicare-approved amount for inpatient respite care.
Home Health Services
Home health care is a wide range of health care services which are administered in your home for an illness or injury. For example, skilled home health care services can include:
Wound care for pressure sores or a surgical wound
Patient and caregiver education
Intravenous or nutrition therapy
Injections
Monitoring serious illness and unstable health status
How Do You Get Home Health Care?
To receive home health care, a doctor must certify that you need one or more of the following:
Intermittent skilled nursing care (other than drawing blood)
Physical therapy
Speech-language pathology
Continued occupational therapy services
Your condition must be expected to improve in a reasonable and generally predictable amount of time. Furthermore, a doctor must certify you are homebound, and your need for home health care must be part-time.
What Else Does Medicare Part A Cover?
To find out if Medicare can cover what you need, talk to your doctor or other health care provider. The following benefits are covered by Medicare Part A:
What Is Not Covered By Part A?
Medicare Part A does not cover outpatient hospital service, which comes under Medicare Part B, or prescription drug coverage, which falls under Medicare Part D. An alternative to these plans is Medicare Part C, also known as the Medicare Advantage Plan (MA Plan).
Medicare Part A Does Not Include:0
Private-duty nursing
Private room (unless medically necessary)
Television and phone in your room (there may be a separate charge for these)
Personal care items such as toothpaste, socks, or razors
24-hour-a-day care at home
Meals delivered to your home
Homemaker services (such as shopping, cleaning and laundry)
Custodial or personal care (such as bathing, dressing or using the bathroom)
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