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What Is Medicare Part A?

You can think of Medicare Part A as your “room and board” in the hospital. It can cover a semi-private hospital room with a bed, three meals per day, and the nurse that comes around to visit you. Medicare Part A benefits include medications given to you by the hospital and any necessary lab services or medical supplies. However, before Medicare Part A can pay anything, you must first pay Part A deductible, which is $1,556 for 2022.

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Medicare Part A: Hospital Coverage

Inpatient hospital care is covered by Medicare Part A when: 1

  1. You are 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.

    AND

  2. The hospital accepts Medicare. In certain cases, the Utilization Review Committee of the hospital approves your stay while you are in the hospital.
Medicare Part A doctor and patient

Before Medicare Part A pays anything, you must first pay Part A deductible $1,556 in 2022.

Medicare Part A: Hospital Coverage

According to CMS, 2 the Part A inpatient hospital deductible can cover your cost for the first 60 days of Medicare-covered inpatient hospital care. For example, you become an inpatient at a hospital on Jan. 1. Happy New Year, you pay the Part A deductible. The next day your doctor discharges you. After 60 consecutive days you have not been admitted as an inpatient. Then on April 1, you get injured and become an inpatient again. Now, you will need to pay the Part A deductible again.

What Does Medicare Part A Cover?

When you enroll in Medicare Part A, in general, it can cover:

  • Inpatient care in a hospital
  • Inpatient care in skilled nursing facility (SNF)
  • Hospice care
  • Home health care

You may receive Medicare services from the following inpatient facilities:

 

  • Acute care hospitals
  • Critical access hospitals
  • Long-term care hospitals
  • Inpatient care as part of qualifying clinical research study
  • Mental health care

Long-Term Care Hospital (LTCH) care

After you have paid your Part A deductible of $1,556 in 2022, Part A pays for long-term care in a LTCH for the first 60 days of hospitalization. However, between 61 days and 90 days you pay. After 90 days, you pay $778 co-insurance per each “lifetime reserve day” in 2022. After being discharged from an LTCH, many people receive care in a skilled nursing facility or custodial care in a long-term care facility.

.

Skilled Nursing Facility (SNF) care

Medicare Part A coverage can include skilled nursing care provided by a SNF under certain conditions and for a limited time. Skilled care is nursing and therapy care that can only be safely and effectively performed by or under the supervision of professionals. It is health care given when you need skilled nursing or skilled therapy to treat, manage, or observe your condition and evaluate your care.

Medicare Part A patient and nurse

What does Skilled Nursing Care cost?

Medicare Part A pays for up to 20 days of skilled nursing or therapy staff. However, you pay $194 co-insurance in 2022 for days 21 to 100. You pay all costs beyond 100 days.

What Can Be Covered in a Skilled Nursing Facility?

  • Semi-private room (a room you share with other patients)
  • Meals
  • Physical therapy
  • Occupational therapy
  • Speech-language pathology services
  • Medical social services
  • Medications
  • Ambulance transportation

Hospice care

Medicare Part A 3 can pay for your hospice care. However, you may need to pay a co-payment of no more than $5 for each prescription drug. For example, drugs for pain relief and symptom control while you are at home. Furthermore, you may need to pay 5% of the Medicare-approved amount for inpatient respite care.

Medicare Part A hospice sunset on water

Home Health Services

Home health care is a wide range of health care services which are administered in your home for an illness or injury. For example, skilled home health care services can include:

  • Wound care for pressure sores or a surgical wound
  • Patient and caregiver education
  • Intravenous or nutrition therapy
  • Injections
  • Monitoring serious illness and unstable health status

How do you get home health care?

To receive home health care, a doctor must certify that you need one or more of the following:

  • Intermittent skilled nursing care (other than drawing blood)
  • Physical therapy
  • Speech-language pathology
  • Continued occupational therapy services
 
Your condition must be expected to improve in a reasonable and generally predictable amount of time. Furthermore, a doctor must certify you are homebound, and your need for home health care must be part-time.

What Else Does Medicare Part A Cover?

To find out if Medicare can cover what you need, talk to your doctor or other health care provider. The following benefits are covered by Medicare Part A:

Medicare Part A can cover blood you get as a hospital inpatient. In most cases, the hospital gets blood from a blood bank at no charge to you. However, if the hospital has to buy blood for you, you will need to pay hospital costs for the first three units of blood in a calendar year. Otherwise, you will need a blood donor. 4

As a hospital patient Medicare Part A can cover blood transfusions. You may receive a blood transfusion to restore blood volume after a serious injury. You may also get blood transfusions to improve the oxygen-carrying capacity of blood due to severe anemia. 5

Medicare Part A can cover cancer treatment, including chemotherapy when you have cancer and are a hospital inpatient. When you are discharged from the hospital, you will need Medicare Part B to pay chemotherapy as a hospital outpatient or in a doctor’s office or clinic. 6

Medicare Part A pays for anesthesia services provided by a hospital if you are an inpatient. However, you will pay 20% of the Medicare-approved amount for the anesthesia services provided by a doctor or certified registered nurse anesthetist. Moreover, the anesthesia service must be associated with the underlying medical or surgical service. In addition, you may have to pay the facility a co-payment. 7

When you meet certain conditions related to morbid obesity, Medicare Part A can pay for some bariatric surgical procedures. For example, gastric bypass surgery and laparoscopic banding surgery may be covered. 8

What Is Not Covered By Part A?

Medicare Part A does not cover outpatient hospital service, which comes under Medicare Part B, or prescription drug coverage, which falls under Medicare Part D. An alternative to these plans is Medicare Part C, also known as the Medicare Advantage Plan (MA Plan).

Medicare Part A does not include:

Sources 9 10
  • Private-duty nursing
  • Private room (unless medically necessary)
  • Television and phone in your room (there may be a separate charge for these)
  • Personal care items such as toothpaste, socks, or razors
  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker services (such as shopping, cleaning and laundry)
  • Custodial or personal care (such as bathing, dressing or using the bathroom)

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Sources

External sources include:

  1. https://www.medicare.gov/coverage/inpatient-hospital-care
  2. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/ge101c03.pdf
  3. https://www.medicare.gov/coverage/hospice-care
  4. https://www.medicare.gov/coverage/blood
  5. https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=154
  6. https://www.medicare.gov/coverage/chemotherapy
  7. https://www.medicare.gov/coverage/anesthesia
  8. https://www.medicare.gov/coverage/bariatric-surgery
  9. https://www.medicare.gov/coverage/inpatient-hospital-care
  10. https://www.medicare.gov/coverage/home-health-services

 

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