Medicare Part A—What's covered?

Also known as Hospital Insurance, Part A helps cover for:

Inpatient care in a hospital
Skilled nursing facility care
Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
Hospice care
Home health care

Senior woman with nurse in skilled nursing at home

INPATIENT HOSPITAL CARE

Medicare Part A covers inpatient hospital care if you meet both of these conditions:

You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
The hospital accepts Medicare.

What's covered in Inpatient Hospital services? Medicare-covered inpatient hospital services include:

Semi-private rooms
Meals
General nursing
Drugs (including methadone to treat an opioid use disorder)
Other hospital services and supplies as part of your inpatient treatment

What's NOT covered?

Private-duty nursing
Private room (unless medically necessary)
Television or phone in your room (if there's a separate charge for these items)
Personal care items (like razors or slipper socks)

Senior woman in hospital with nurse and doctor

SKILLED NURSING FACILITY CARE

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.

Part A covers skilled nursing care for a limited time (on a short-term basis) if all of these conditions apply:

You have Part A and have days left in your benefit period to use.
You have a qualifying inpatient hospital stay.
Your doctor has decided that you need daily skilled care. You must get the care from, or under the supervision of, skilled nursing or therapy staff.
You get these skilled services in a Medicare-certified SNF.
You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay (not including the day you leave the hospital), even if it wasn't the reason you were admitted to the hospital.
- A condition that started while you were getting care in the SNF for a hospital-related medical condition (for example, if you develop an infection that requires IV antibiotics while you're getting SNF care)

What's covered for Skilled Nursing Facility (SNF) care? Medicare-covered services in a skilled nursing facility include, but aren't limited to:

A semi-private room
Meals
Skilled nursing care
Physical, Occupational, or Speech-language therapy (if needed to meet your health goal)
Medical social services
Medications (Part B)
Medical supplies and equipment used in the facility
Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF
Dietary counseling

Long-term care hospital services

Long-term care hospitals specialize in treating patients with more than 1 serious medical condition who are hospitalized for 25 days or more. The patients may improve with time and care, and eventually return home. Long-term care hospitals typically give services like respiratory therapy, head trauma treatment, and pain management.

Keep in mind: Medicare does NOT cover long-term care, such as extended stays in a nursing home. You can consider purchasing long-term care insurance with us if this is something you want to plan for.

To learn more about Part A or get help with your Medicare insurance Call Us at 888-801-9097!

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Source: medicare.gov

Medicare Part A—What's covered?

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