Medicare Part A Hospital Insurance (Inpatient)
What does Part A cover?
Part A covers:
- Hospital Inpatient Care
- Skilled Nursing Facility (SNF) Care
- Home Health Care
- Hospice Care
Be aware that each type of care has its own set of criteria that must be met in order for Medicare to cover it. There are also limits on the amount of care that will be covered.
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What are the costs of Part A?
Premium: There is no monthly Part A premium for people who have at least 40 quarters of Social Security credits. People who have contributed less than 40 quarters to Social Security and meet the citizenship and residency requirements may be eligible to purchase Part A for a monthly premium. See Part A Medicare Premiums & Deductibles.
Deductible: For each hospital stay within a benefit period or spell of illness, there is a deductible (see details in "Hospital Inpatient Care" section below). After the deductible is met, there are no co-payments for covered services until the 61st day of hospitalization. NOTE: covered services do not include a private room unless medically necessary.
For Medicare-covered skilled nursing care, there are no co-payments for the first 20 days. From the 21st to 100th days, there is a co-payment.
Hospital Inpatient Care
Covered hospital inpatient services include:
- Hospital room and board
- Routine nursing services
- Most drugs provided for use in the hospital
- Physical, speech, and occupational therapy
- Services provided by medical doctors, residents, and interns
Benefit period (spell of illness): A benefit period begins the day a beneficiary is admitted to the hospital for a Medicare-covered stay of any kind and continues for 60 days immediately following a Medicare-covered hospital or skilled nursing facility stay.
Example 1: A patient is hospitalized for pneumonia and subsequently discharged. The patient must pay the deductible. Four days later the patient has a heart attack and is hospitalized for surgery. No deductible is required.
Example 2: A patient is hospitalized for a small stroke and subsequently discharged. The patient must pay the deductible. Three months later, the patient is hospitalized for a second stroke. Since the beneficiary has not received Medicare-covered hospital or nursing home care for more than 60 days, a new benefit period begins and the patient must pay another deductible.
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Skilled Nursing Facility (SNF) Care
Requirements for coverage:
- The Skilled Nursing Facility (SNF) is Medicare-certified.
- The patient has been hospitalized for at least three consecutive days immediately prior to entering the SNF. NOTE: If the patient belongs to a Part C Medicare Advantage Plan HMO, SNF care may begin earlier. Check with your plan for specific details.
- The patient needs "skilled nursing" or rehabilitation services on a "daily basis." "Skilled nursing" care is defined as a nursing or rehabilitation therapy service that requires the special skills of technical or professional health personnel. "Daily basis" means the care must be provided at least five days per week. Custodial or personal care services do not require skilled care.
- The skilled services must be ordered by the patient's physician.
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Home Health Care
Requirements for coverage:
- The home health agency must be Medicare-certified.
- The beneficiary must be confined to the home.
- The beneficiary must need at least one of the following skilled services daily: physical therapy, speech therapy, ongoing occupational therapy, or skilled nursing care.
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Hospice Care
Hospice care is designed for persons who are terminally ill and whose doctor expects that they have less than six months to live. Medicare will pay for care from a Medicare-certified hospice.
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What if the hospital wants to discharge me too early?
If you are told you will be discharged from the hospital before you feel well enough to go home, you may file an appeal to Medicare's Quality Improvement Organization (QIO), currently administered through Health Services Advisory Group, Inc. (HSAG). To file the appeal, you or a loved one may call 1-800-841-1602 by noon the day after you have been informed of the discharge plan. There is no charge for this service. Once the appeal is filed, you will neither be discharged nor billed for the time while your situation is investigated. HSAG will notify you and the hospital of the outcome. For more information, please call HICAP at 1-800-434-0222.
If you are covered by a Medicare Advantage plan, you may also ask for a QIO instead of a 72-hour appeal. See Medicare Appeals.
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What are the different levels of inpatient care?
There are three, commonly-classified levels of inpatient care:
- Acute: Care that requires short-term hospitalization.
- Skilled-nursing (sometimes called sub-acute): Care that requires professional, skilled nursing or rehabilitation services on a daily basis.
- Custodial (also called long-term care): Ongoing, personal care that requires non-skilled assistance, such as help with everyday activities like dressing, bathing, and using the bathroom. This type of care is not covered by Medicare. For more information on custodial care, see the Long-Term Care and Caregiving sections of this website.
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