What services does Medicare Part A cover and what are the costs?

Medicare Part A is the portion of the Medicare program that covers hospital insurance. It primarily involves inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. Here’s a breakdown of the services that is offers.

Inpatient hospital care

This includes semi-private rooms, meals, general nursing, and other hospital services and supplies. It covers things like hospital stays, surgeries, and treatments received as an inpatient.

Skilled nursing facility care

Medicare Part A covers skilled nursing care and rehabilitation services in a certified SNF following a qualifying hospital stay. This coverage includes necessary care, such as physical therapy, speech-language pathology services, and occupational therapy.

Nursing home care

This refers to inpatient care in a skilled nursing facility that’s not custodial or long-term care.

Hospice care

Medicare Part A covers hospice care for individuals with a terminal illness and a life expectancy of six months or less. It includes services like pain relief, symptom management, and emotional and spiritual support.

Home health care

The insurance covers a limited range of home health care services if they are deemed medically necessary. These services typically include part-time skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services.

Medicare Part A limitations

Medicare Part A coverage is subject to certain conditions and limitations. For instance, it usually requires meeting specific eligibility criteria and may have limitations on the duration and frequency of services. Also, the program does not cover long-term care in a nursing home, custodial care, or most care received outside the United States.

What are the costs of Medicare Part A?

Most people do not pay a premium for Medicare Part A if they or their spouse paid Medicare taxes while working. If you don’t get premium-free Part A, you have to pay up to $506 per month, according to the Medicare website.

There are other costs associated with Part A, such as deductibles and coinsurance.

Deductible

In 2023, the Medicare Part A deductible for each benefit period is $1,600. This means that beneficiaries are responsible for paying this amount out-of-pocket before Medicare coverage begins.

Coinsurance

After the deductible is met, Medicare Part A generally covers the full cost of covered services for the first 60 days of a hospital stay. However, for stays longer than 60 days, beneficiaries are responsible for paying a daily coinsurance amount.

For example, for days 61-90 of each benefit period, the coinsurance amount is $400 per day in 2023. For stays beyond 90 days, beneficiaries can use their “lifetime reserve days” which provides coverage for additional days but with a higher coinsurance amount ($800 per day in 2023).

Skilled Nursing Facility stay

This year, there is no cost for the first 20 days of the benefit period, then it becomes $200 per day for days 21-100 of the stay. After day 100, you have to pay all costs for each day of the stay at the facility.