Medicare Part A (Hospital Insurance) Coverage
Medicare Part A will pay for most of the costs of your hospital stay, after you pay the Part A deductible.
Medicare Part A is also called "hospital insurance," and it covers most of the cost of care when you are at a hospital or skilled nursing facility as an inpatient. Medicare Part A also covers hospice services. For most people over 65, Medicare Part A is free.
The following list gives you an idea of what Medicare Part A pays for, and does not pay for, during your stay in a participating hospital. However, even when Part A covers a cost, there are significant financial limitations on the length of coverage, as you'll see below.
What Medicare Part A Covers
When you are admitted to a hospital or skilled nursing facility, Medicare Part A hospital insurance will cover the following for a certain amount of time:
• a semiprivate room (two to four beds per room), or a private room if medically necessary
• all meals, including special, medically required diets
• regular nursing services
• special care units, such as intensive care and coronary care
• drugs, medical supplies, and appliances furnished by the facility, such as casts, splints, wheelchair; also, outpatient drugs and medical supplies if they permit you to leave the hospital sooner
• hospital lab tests, X-rays, and radiation treatment billed by the hospital
• operating and recovery room costs
• blood transfusions (you pay for the first three pints of blood, unless you arrange to have them replaced by an outside donation of blood to the hospital), and
• rehabilitation services, such as physical therapy, occupational therapy, and speech pathology, provided while you are in the hospital.
What Medicare Part A Does Not Cover
Medicare Part A hospital insurance does not cover:
• personal convenience items such as television, radio, or telephone
• private duty nurses, or
• a private room when not medically necessary.
How Much Medicare Pays for You to Stay in a Hospital
Medicare Part A pays only certain amounts of a hospital bill for any one spell of illness. (And for each spell of illness, you must pay a deductible before Medicare will pay anything. In 2013, the hospital insurance deductible is $1,184.)
For the first 60 days you are an inpatient in a hospital, Part A hospital insurance pays all of the cost of covered services. After your 60th day in the hospital and through your 90th day, each day you must pay what is called a “coinsurance amount” toward your covered hospital costs, and Medicare will pay the rest of covered costs. In 2013, this daily coinsurance amount is $296; it goes up every year.
If you are in the hospital more than 90 days during one spell of illness, you can use up to 60 additional "lifetime reserve" days of coverage. During those days, you are responsible for a daily coinsurance payment of $592 per day in 2013. Medicare pays the rest of covered costs.
You do not have to use your reserve days in one spell of illness; you can split them up and use them over several benefit periods. But you have a total of only 60 reserve days in your lifetime.
(Note: If you have a Medicare Advantage Plan, called Medicare Part C, you may not have to pay the deductible and coinsurance amounts for hospital stays.)
What Constitutes One Spell of Illness
A spell of illness, called a "benefit period," refers to the time you are treated in a hospital or skilled nursing facility, or some combination of the two. The benefit period begins the day you enter the hospital or skilled nursing facility as an inpatient and continues until you have been out for 60 consecutive days. If you are in and out of the hospital or nursing facility several times but have not stayed out completely for 60 consecutive days, all your inpatient bills for that time will be figured as part of the same benefit period (even if you are readmitted for a different illness or injury).
Skilled Nursing Facilities and Home Health Care
Under some circumstances, Medicare will cover some of the cost of inpatient treatment in a skilled nursing facility or visits from a home health care agency. Your stay in a skilled nursing home facility or home health care is covered by Medicare Part A only if you have spent three consecutive days, not counting the day of discharge, in the hospital. Your skilled nursing stay or home health care must begin within 30 days of being discharged. For more information, see our articles on Medicare coverage of skilled nursing facilities and Medicare coverage of home health care.
Medicare Part A hospital insurance covers a total of 190 days in a lifetime for inpatient care in a specialty psychiatric hospital (meaning one that accepts patients only for mental health care, not just a general hospital).
If you are already an inpatient in a specialty psychiatric hospital when your Medicare coverage goes into effect, Medicare may retroactively cover you for up to 150 days of hospitalization before your coverage began. In all other ways, inpatient care in a psychiatric hospital is governed by the same rules regarding coverage and copayments as regular hospital care.
There is no lifetime limit on coverage for inpatient mental health care in a general hospital. Medicare will pay for mental health care in a general hospital to the same extent as it will pay for other inpatient care.