Part A covers inpatient or hospital care.
Hospital care includes:
- Skilled nursing facility care
- Nursing home care (as long as custodial care isn’t the only care you need)
- Home health services (in limited circumstances)
To compare hospitals, use Medicare’s Hospital Compare tool.
Part A costs
You usually don’t pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.” If you buy Part A, you will pay a premium each month.
You can get premium-free Part A at 65 if:
- You already get retirement benefits from Social Security or the Railroad Retirement Board.
- You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
- You or your spouse had Medicare-covered government employment.
If you’re under 65, you can get premium-free Part A if:
- You’ve received Social Security or Railroad Retirement Board disability benefits for 24 months.
- You have End-Stage Renal Disease (ESRD) and meet certain requirements.
- You have ALS (Lou Gehrig’s disease)
Part A coverage
Depending on specific circumstances, the following are health care services which Part A may cover:
Where are you covered under Part A?
Hospital Care can be received at any of the following scenarios:
- Acute care hospitals
- Critical access hospitals
- Inpatient rehabilitation facilities
- Long-term care hospitals
- Mental health care
- Participation in a qualifying clinical research study
Skilled Nursing Facility (SNF) care
Medicare Part A covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited amount of time.
Skilled nursing facility care includes:
- Semi-private room (a room you share with other patients)
- Skilled nursing care
- Physical and occupational therapy (if they’re needed to meet your health goal)
- Speech-language pathology services (if they’re needed to meet your health goal)
- Medical social services
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
- Dietary counseling
Note: Beware of “observation status.” Observation is a period when you are being observed to see if you need to be admitted to a hospital, and observation days considered outpatient and are not covered under Part A.
Inpatient or outpatient?
See what Medicare will (or won’t) pay in each of these situations:
Nursing home care
Medicare Part A may cover care in a skilled nursing facility (SNF) it’s medically necessary. Most nursing home care falls under custodial care, which is not covered under Part A.
Note: Custodial care, such as bathing and dressing, is not covered if that’s the only care you need.
To find a nursing home and compare nursing homes, search Medicare’ Nursing Home Compare tool.
Hospice care is for people with a life expectancy of 6 months or less. This kind of care is done by a team that includes you and your family, as well as doctors, nurses, social workers, pharmacists, and other team members. You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods (if you are recertified to have a low life-expectancy). To find hospice care, search Medicare’s Hospice Compare site.
Hospice care includes:
- Doctor services
- Nursing care
- Pain relief medications
- Social services
- Durable medical equipment
- Medical supplies
- Hospice aide services
- Homemaker services
- Physical and occupational therapy
- Dietary counseling
- Short-term inpatient care (if necessary for managing pain or symptoms)
- Short-term respite care
Home health services
Home health services are only covered if a doctor certifies that you are homebound, you are under the care of a doctor, and you are in need of the services listed below. Note that Part A will not cover around-the-clock home care except in short-term special circumstances that your condition requires. If in doubt about whether Medicare covers something, talk to your doctor, or search Medicare’s site.
Home Health services include:
- Intermittent skilled nursing care
- Physical therapy
- Speech-language pathology services
- Continued occupational services, and more.
What will Part A not cover?
Part A will not cover:
- A private room (unless medically necessary)
- Private-duty nursing
- Personal care items, like razors or slipper socks
- Extra charges, like telephone or TV
- Non-donated blood
- Meals delivered to your home
- 24-hour-a-day care at home
- Homemaker services
- Personal care
- Custodial (long-term) care