Medicare Part A is often called hospital insurance. It can help pay for certain inpatient care when you are formally admitted to a hospital. It may also help with limited care in a skilled nursing facility, hospice care, and some home health services.
Many people get Medicare Part A without a monthly premium because they or a spouse paid Medicare taxes while working. Even so, Part A is not free care. Deductibles, copayments, and coverage rules can apply.
Knowing what Part A covers may help you prepare for Medicare and avoid surprises if you need hospital care later.
What is Medicare Part A?
Medicare Part A is one half of Original Medicare. The other half is Medicare Part B, which generally helps cover outpatient care, doctor visits, medical tests, and preventive services.
Part A is mainly designed for care that happens after a doctor formally admits you to a hospital or another covered facility. Your doctor and the hospital decide whether you are admitted as an inpatient. Simply staying overnight does not always mean you are an inpatient.
This distinction can matter. For example, a person may stay in a hospital under observation status, which is usually considered outpatient care rather than inpatient care. In that case, Part B may apply instead of Part A.
Does Medicare Part A cover hospital stays?
Yes. Medicare Part A can help cover inpatient hospital care at a hospital that accepts Medicare. Coverage may include a semi-private room, meals, general nursing, medications given during your stay, and other hospital services.
Part A can also help cover services such as operating room care, lab tests, imaging, and supplies when they are part of your inpatient treatment. However, doctors who treat you in the hospital usually bill Medicare Part B separately.
Part A coverage is based on a benefit period, not a calendar year. A benefit period generally begins the day you are admitted to a hospital or skilled nursing facility. It may end after you have been out of inpatient or skilled nursing care for 60 days in a row.
During each benefit period, you may need to pay a Part A deductible before Medicare begins paying its share. If your hospital stay lasts beyond a certain number of days, daily copayments may apply. The amount can change from year to year.
What does Part A cover after a hospital stay?
Medicare Part A may help pay for care in a skilled nursing facility, often called an SNF. This is not the same as long-term nursing home care or help with daily living.
Skilled nursing facility care may include services such as physical therapy, occupational therapy, speech therapy, wound care, and certain medications. To qualify, you generally need a qualifying inpatient hospital stay first and a medical need for skilled care on a daily basis.
There are important limits:
- You generally need at least a three-day inpatient hospital stay before skilled nursing facility coverage can begin.
- Observation time in a hospital may not count toward that three-day requirement.
- The facility must generally be Medicare-certified.
- Part A coverage is limited to a set number of days during each benefit period.
- Copayments may apply after the first portion of a covered stay.
It is a good idea to ask the hospital discharge planner whether you meet the requirements before moving to a skilled nursing facility.
Does Medicare Part A cover nursing home care?
Part A may cover short-term skilled nursing facility care when Medicare rules are met. However, it generally does not cover long-term custodial care in a nursing home.
Custodial care means help with everyday tasks, such as bathing, dressing, eating, or using the bathroom, when that is the main type of care needed. Many families are surprised to learn that Medicare does not generally pay for an extended nursing home stay that is only for personal care.
Medicaid, long-term care insurance, personal savings, and other resources may play a role in paying for long-term care, depending on a person's situation.
How does Medicare Part A cover hospice care?
Medicare Part A can cover hospice care for people with a terminal illness when a doctor and the hospice medical director certify that the person is eligible. Hospice focuses on comfort, pain management, emotional support, and quality of life rather than treatment intended to cure the illness.
Hospice care may be provided at home, in a hospice facility, in a nursing facility, or sometimes in a hospital. Covered services can include nursing care, counseling, medical equipment, medications related to comfort, and support for family caregivers.
You may still have coverage for medical care that is not related to the terminal illness. The details can depend on the situation, so it is helpful to ask the hospice team how billing will work.
What home health services may Part A cover?
Part A may help cover some home health services if you meet Medicare's eligibility rules. In many cases, Part B may cover home health care instead, depending on your circumstances and whether you have had a qualifying hospital or facility stay.
Covered home health services may include part-time skilled nursing care, physical therapy, occupational therapy, speech therapy, and certain medical social services. Medicare may also cover some medical equipment for use at home, although different cost-sharing rules can apply.
Home health care is generally not around-the-clock care. It also does not usually cover full-time personal care, meal delivery, or housekeeping when those are the only services needed.
What does Medicare Part A usually not cover?
Part A has helpful hospital-related benefits, but it does not pay for everything. It generally does not cover:
- Most routine doctor visits and outpatient services
- Routine dental, vision, and hearing care
- Long-term custodial nursing home care
- Private-duty nursing
- A private hospital room unless it is medically necessary
- Personal items such as television or phone charges in many cases
- Most prescription drugs you take at home
Medicare Part D may help with many outpatient prescription drugs. A Medicare Supplement plan may help pay certain out-of-pocket costs left by Original Medicare, such as some Part A deductibles and coinsurance. Benefits, premiums, and availability can vary by plan, insurance carrier, and state.
Why understanding Part A matters
Part A can provide valuable protection if you need inpatient hospital care or a short period of skilled recovery care. Still, its deductibles, benefit periods, and coverage rules may be confusing at first.
Before a planned hospital stay, consider asking whether you will be admitted as an inpatient, what services are expected after discharge, and whether a facility accepts Medicare. These simple questions may help you understand which part of Medicare could apply.
If you would like help understanding how Medicare Part A works with Medicare Supplement coverage, Eric can offer free, no-pressure guidance. With 25 years of experience, he can help you review your options and ask the right questions for your situation.