What Does Medicare Part A Cover?

For the most part, Medicare Part A covers Inpatient care in a hospital, Skilled Nursing Facility Care, Home Health Care & Hospice Care.

Part A covers four main categories of services, let’s look at each one in more depth.

Inpatient Hospital Care

Medicare Part A health insurance will cover inpatient hospital care as long as a doctor orders the stay due to medical necessity, and the hospital accepts Medicare for payment.

Some Medicare costs are associated with a hospital stay, including a deductible of $1,600 per benefit period. A benefit period begins when you’re admitted to the hospital and ends 60 days after discharge as long as no additional hospital services are obtained.

There are no further expenses for the first 60 days of inpatient care, providing health care providers only order services that are covered by Medicare. After that, coinsurance payments are required for extended stays.

The following list shows the required payments per benefit period:

  • Days 61-90: $400 per day
  • Days 91 and beyond: $800 per lifetime reserve day

Each beneficiary receives 60 lifetime reserve days for their lifetime. When those are used, Medicare Part A will no longer cover inpatient hospital care beyond 90 days in a single benefit period.

Skilled Nursing Facility Care

Medicare Part A coverage for skilled nursing facility care is limited to care needed after a qualifying inpatient hospital stay. Extended stays are often approved if an infection or another medical condition develops while a beneficiary is in a skilled nursing facility recovering from an inpatient hospital stay. Beneficiaries must stay in the hospital for at least three days, not counting their discharge day, to qualify for skilled nursing facility care.

There is no deductible for care in a nursing home or another skilled nursing facility.

Coinsurance does apply, according to the following schedule:

  • Up to 20 days – $0
  • Days 21-100 – up to $200.00 per day

Beneficiaries are responsible for all costs if their stay lasts longer than 100 days.

Home Health Services

Home health care services include a variety of health care services that are performed by medical professionals in a beneficiary’s home.

Some covered services include:

  • Physical therapy
  • Occupational therapy
  • Skilled nursing care (part-time or intermittent only)
  • Osteoporosis injectable drugs
  • At-home medical supplies
  • Durable medical equipment like wheelchairs
  • Home health aide care (part-time only, while receiving other skilled nursing services)

Medicare covers these services only if a beneficiary is certified home-bound and in medical need by a doctor. This care is provided free of charge as long as all services ordered are covered by Part A. Medicare Part B will cover up to 80% of durable medical equipment after a beneficiary meets the annual deductible for Part B.

Hospice Benefits

Part A hospice coverage differs from all other portions of the Medicare health plan because it requires a more emotional commitment from the beneficiary.

To qualify for hospice care coverage, beneficiaries must do the following:

  • Accept comfort or palliative care instead of health care services designed to heal and cure
  • Sign a document stating that they agree to receive hospice care in place of other services that Medicare might cover

A medical provider must also certify that the beneficiary is terminally ill, defined as having a life expectancy no longer than six months.

Most hospice care services are covered 100% by Medicare Part A. Some exceptions include copayments of up to $5 for each prescription ordered for pain management and comfort. In addition, part A hospice will not cover medications intended to heal or treat medical conditions. Some medications not covered by Part A are covered by Medicare Part D.

Beneficiaries may also pay 5% of respite care received while under the care of a hospice team.

What Does Medicare Part A Not Cover?

Medicare Part A covers a lot, but some services are not included.

This list only represents some of the most common exclusions:

  • Private room in a hospital or skilled nursing facility
  • Routine outpatient screenings and diagnostic procedures
  • Private nursing care inpatient or outpatient
  • Hospital luxuries like telephones and televisions
  • First 3 pints of blood (Medigap policies may cover this)
  • Skilled nursing facility care without an inpatient hospital stay of at least three days
  • Room and board at a skilled nursing facility while receiving coverage for hospice
  • Hospital services are delivered in “observation” status rather than “admitted” status

Beneficiaries also receiving Medicaid services may have coverage for some of these expenses. Enrolling in a Medicare Advantage plan or Medicare Supplement plan may also lead to fewer out-of-pocket costs for some beneficiaries.

How to Enroll in Medicare Part A

If you receive disability benefits from Social Security or the Railroad Retirement Board (RRB) for a total of 24 months, you will receive automatic enrollment in Medicare Part A when you turn 65. You may also qualify for Original Medicare coverage before turning 65 if you’re permanently disabled or are diagnosed with end-stage renal disease.

If you aren’t automatically enrolled, the best time to do so is during your 7-month initial enrollment period. The period includes the month you turn 65 plus the three months before and after. If you enroll during the three months before your birthday month, your coverage will start on the first day of the month you turn 65. If your birthday is on the first day of the month, then your coverage will start the first day of the month before your birthday month.

If you enroll during your birthday month or the three months following, you will have a delay before your coverage begins. Coverage will start the following month if you enroll during your birth month. If you enroll during the three months following your birth month, your coverage will have a 2- or 3-month delay.

Most beneficiaries qualify for premium-free Part A, so there is no monthly premium to increase as a penalty for late enrollment. However, beneficiaries are still likely to pay a higher Part B premium if they enroll outside this period without qualifying for a special enrollment period.

If you miss your initial enrollment period, you can enroll in Medicare Part A during the annual general enrollment period from January 1 through March 31.

You can enroll in Medicare Part A and Part B through your local Social Security office or by filling out the online form. You can also call 1-800-325-0778 to get help applying over the phone. For beneficiaries who worked for the railroad or with a spouse who worked for the railroad, calling 1-877-772-5772 will help with the application process.

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Mark Prip

Since 2003, Mark Prip has been leading  Policy Guide, Inc., providing knowledgeable information about Medicare, life insurance, and dental coverage to clients in over forty states. With his unparalleled hands-on experience aiding countless Medicare beneficiaries in selecting an appropriate health plan - it's clear that he is a prime example amongst other competitors for expertise and assistance. Mark has held is Florida Health & Life Insurance License (E051889) since 2003. View his license profile on the Florida Department of insurance website.