Medicare Hospital Coverage: What You Need to Know

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Are you afraid that your hospital stay won’t be covered by your Medicare plan? Medicare covers hospital care under Part A

Medicare Part A includes hospital care, care received in a skilled nursing facility, hospice care, and limited home health services. Note that there are limits on what Medicare covers for these services. 

Basic care included under an inpatient hospital stay are a semi-private room, meals, general nursing, drugs administered in the hospital, and other services and hospital supplies. 

Understanding Medicare Part A

Medicare Part A covers inpatient care. You will probably be automatically enrolled in Part A whenever you turn 65. If you are not already enrolled in Part B and need to enroll manually, you can do so during your initial enrollment period, which is a six-month window that begins three months before you turn 65. 

Part A deductible

The Part A deductible is the amount you’ll have to pay before Medicare starts covering your hospital bills. 

The Part A deductible for 2021 is $1,484, and applies to each benefit period rather than calendar year. A benefit period in Part A begins the day you’re admitted to the hospital and ends when you haven’t received any inpatient for 60 days in a row. 

Part A Coinsurance 

Part A coinsurance is the percentage of your hospital costs that you are responsible for. A Medigap plan can help cover these costs. 

If you are admitted to the hospital, you will pay the following coinsurances (or percentages of services) in addition to your deductible:

  • Days 1 – 60: $0
  • Days 61 – 90: $371 per day
  • Days 91 – lifetime reserve days: $742 per day until you have used up your 60 lifetime reserve days (you get 60 lifetime reserve days over the course of your life)
  • Beyond lifetime reserve days: all costs

The same coverage and costs apply to a mental health hospital, but you will have to pay an additional 20 percent for Medicare-approved services and treatments.

After a benefit period has ended, your benefits will start over. If you are readmitted to the hospital after going more than 60 days without receiving inpatient care, you will have to pay your deductible again, but you will also not owe any coinsurance for the first 60 days. 

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Part A skilled nursing facility

If you are admitted to a skilled nursing facility, the daily coinsurance rates are:

  • Days 1 – 20: $0 
  • Days 21 – 100: $185.50 per day
  • Days 101 and beyond: all costs

All coinsurance rates for skilled nursing facilities are subject to benefit periods. 

What’s not covered?

Medicare doesn’t cover everything, so you may have to pay out of pocket for certain services. Even if Medicare covers the costs of a service or piece of equipment, you will most likely still have to pay your copayment, coinsurance, and the Part A deductible, which is $1,484 in 2021. 

Some examples of services that Part A does not cover are:

  • A private room (unless medically necessary)
  • Private-duty nursing
  • Personal care items, like razors or slipper socks
  • Extra charges, like a telephone or TV in your room
  • Non-donated blood
  • Meals delivered to your home
  • 24-hour-a-day care at home
  • Homemaker services
  • Personal care
  • Custodial (long-term) care

Talk to your doctor to find out specifics about what Medicare won’t cover.

Important terms to note

Lifetime reserve day- A patient gets only 60 of these over their lifetime. These are any day over 90 days in the hospital, and hold a higher coinsurance rate.

Benefit period- A benefit period in Part A begins on the first day you’re admitted to the hospital and ends after you’ve spent 60 days in a row out of the hospital. 

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