What Medicare Part A Covers in Hospital Settings
Medicare Part A is the hospital insurance portion of Medicare. It covers inpatient hospital care, skilled nursing facility care, hospice care, and home health services. Understanding what Part A covers helps you know what costs you may face when you receive hospital treatment.
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When you stay in a hospital as an inpatient under Part A, Medicare covers the costs of your hospital room, meals, nursing care, medications given during your stay, lab tests, X-rays, and surgical procedures performed at the hospital. Part A also covers necessary medical supplies and equipment used during your inpatient stay, such as wheelchairs, hospital beds, or oxygen equipment provided by the hospital.
According to Medicare data, approximately 45 million people were enrolled in Medicare as of 2023, with the vast majority having Part A coverage. In 2022, Medicare Part A covered approximately 9 million hospital stays for beneficiaries across the United States.
Part A does not cover all hospital-related costs. For example, it does not cover private duty nursing, a television or telephone in your room, or personal comfort items you bring with you. It also does not cover certain types of care that are considered experimental or not medically necessary according to Medicare's standards.
One important distinction is that Part A only covers inpatient hospital stays. If you go to a hospital's emergency room and are discharged the same day without being admitted as an inpatient, that care is typically covered under Medicare Part B (medical insurance), not Part A. This distinction can affect your costs and what portion of the bill Medicare pays.
Takeaway: Before entering a hospital, understand that Part A covers your room, meals, nursing, medications, tests, and procedures during an inpatient stay, but you remain responsible for certain costs like deductibles and copayments that are explained in other sections of this guide.
Understanding Deductibles, Copayments, and Your Out-of-Pocket Costs
Even with Medicare Part A coverage, you have costs to pay. These include a deductible, daily copayments, and costs after your coverage ends. The amounts change each year. In 2024, the Part A hospital deductible is $1,632 per benefit period. A benefit period begins when you enter the hospital and ends when you have not received inpatient hospital care for 60 consecutive days.
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After you pay the deductible, you do not pay anything for days 1 through 60 of your hospital stay. However, for days 61 through 90 of the same benefit period, you pay a daily copayment. In 2024, this copayment is $408 per day. If your hospital stay extends beyond 90 days, Medicare Part A includes what is called "lifetime reserve days." You have 60 lifetime reserve days total that you can use during your entire lifetime. Once you use these 60 reserve days, Medicare does not pay for additional hospital days in that benefit period. The daily copayment for using lifetime reserve days is $816 per day in 2024.
These costs can add up quickly for extended hospital stays. For example, a patient who stays in the hospital for 100 days in 2024 would pay the $1,632 deductible, nothing for days 1 through 60, $408 per day for days 61 through 90 (which equals $12,240), and $816 per day for days 91 through 100 (which equals $8,160). The total out-of-pocket cost would be $22,032 before considering other expenses.
It is important to note that once you have paid the Part A deductible in a benefit period, you do not pay it again for additional hospital stays within that same benefit period. However, a new benefit period can begin, requiring you to pay a new deductible. This reset happens 60 days after you leave the hospital if you do not return.
Some people have supplemental insurance, sometimes called Medigap insurance, which pays some or all of your Medicare out-of-pocket costs. Others have Medicaid or are covered through a Medicare Advantage plan, which may structure costs differently. Understanding your specific coverage situation is essential for knowing your actual financial responsibility.
Takeaway: Budget for a $1,632 deductible and potential daily copayments if you need a hospital stay lasting longer than 60 days, and explore whether you have additional insurance that might cover these costs.
Skilled Nursing Facility Care Covered by Part A
Medicare Part A also covers care in a skilled nursing facility (SNF) when specific conditions are met. A skilled nursing facility is not the same as a regular nursing home or assisted living facility. It is a facility where patients receive skilled nursing care or rehabilitative care ordered by their doctor.
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To receive SNF coverage through Part A, you must meet several requirements. First, you must have been in a hospital as an inpatient for at least three consecutive days (not counting the discharge day) before being admitted to the SNF. Second, you must be admitted to the SNF within 30 days of leaving the hospital. Third, a doctor must determine that you need daily skilled nursing or rehabilitation services that can only be provided in a skilled nursing facility. The care you receive must be for the same condition or a related condition that caused your hospital stay.
When Part A covers your SNF stay, it covers all costs for the first 20 days with no copayment. For days 21 through 100 of your SNF stay, you pay a daily copayment. In 2024, this copayment is $204 per day. After 100 days in a benefit period, Medicare Part A does not pay for additional SNF care in that benefit period.
Part A covers the room, meals, nursing services, medications, therapy services, medical equipment, and supplies provided by the SNF. However, it does not cover personal care items, telephone, television, or custodial care that is not skilled care. Custodial care refers to help with activities of daily living like bathing, dressing, or eating, when skilled nursing is not involved.
According to data from the Centers for Medicare and Medicaid Services, in 2021, Medicare Part A paid for approximately 2.3 million SNF stays. Many patients transition from hospital stays to SNF care as part of their recovery process before returning home.
Takeaway: If you need rehabilitation or skilled nursing care after a hospital stay, Part A may cover SNF care for up to 100 days in a benefit period, but you must be admitted within 30 days of leaving the hospital and must have spent at least three days hospitalized first.
Home Health Services and Part A Coverage
Medicare Part A covers home health services when your doctor determines you are homebound and need skilled care or therapy at home. Home health care allows you to receive medical treatment in your own home rather than in a facility. This may include nursing care, physical therapy, occupational therapy, speech therapy, social work services, and home health aide services.
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Unlike hospital or SNF care, there is no deductible for home health services covered by Part A. Part A pays the full cost of medically necessary home health services with no copayment or coinsurance when you use a Medicare-participating home health agency. However, you may have costs for certain equipment. If the home health agency provides medical equipment such as a wheelchair, walker, or oxygen equipment, you pay 20 percent of the Medicare-approved amount for that equipment after you have met your Part B deductible.
To receive Part A coverage for home health services, your doctor must order the care and determine that you are homebound. Being homebound means that leaving your home requires considerable and taxing effort, or that your medical condition makes it medically inadvisable to leave. You do not need to be completely unable to leave your home; for example, you might make occasional trips to a doctor's office or to a place of worship.
The care must be skilled care, meaning it requires the skills of a nurse, therapist, or other skilled professional. Part A does not cover custodial care, such as help with bathing or dressing, unless it occurs as part of a skilled care visit. For example, if a home health nurse visits to check your wound and also helps you bathe, the visit is covered because the primary purpose is skilled nursing care.
In 2022, according to the Centers for Medicare and Medicaid Services, Medicare paid