Part A (Hospital)

Part A Coverage Basics

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)
• Hospice
• 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)

Where are You Covered Under Part A?

Depending on specific circumstances, the following are health care services that Part A may cover:

Where are you covered under Part A?

Hospital Care can be received in 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)
• Meals
• 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
• Medications
• 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’s Nursing Home Compare tool.

Hospice care

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.

• Intermittent skilled nursing care
• Physical therapy
• Speech-language pathology services
• Continued occupational services, and more.

Part A Coverage Basics

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 a 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