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.

By , Attorney

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 Does Medicare Part A Cover?

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 semi-private 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 Is Not Covered by Medicare Part A?

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 Does Medicare Pay for You to Stay in a Hospital?

Medicare doesn't cover 100% of hospital bills. 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 2023, the hospital insurance deductible is $1,556.

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 you pay the deductible).

After your 60th day in the hospital, 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. Here's what you'll pay in 2023:

  • Hospital days 1-60: $0 coinsurance per day
  • Hospital days 61-90: $400 coinsurance per day
  • Hospital days 91 and beyond: $800 coinsurance per each lifetime reserve day

If you're in the hospital for more than 90 days during one spell of illness, you can use up to 60 additional "lifetime reserve" days of coverage. You don't 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).

What Other Types of Care Does Part A Cover?

Medicare also covers other types of facilities and services, but only in some circumstances.

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 from the hospital. For more information, see our articles on Medicare coverage of skilled nursing facilities and Medicare coverage of home health care.

Psychiatric Hospitals

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're 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 the 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.

Hospice Care

Medicare Part A will pay for hospice care provided by a Medicare-certified program in the following circumstances:

  • a doctor and the hospice medical director must verify that the patient has a terminal illness and probably has less than six months to live, and
  • the patient must sign a statement choosing hospice care instead of standard Medicare-covered benefits—although Medicare will continue to cover health problems that are not related to the terminal illness.

If hospice care will be received at home, caregivers should find out the amount of services that will be provided before agreeing to give up standard medical benefits; sometimes nursing and other services provided in the home environment are quite limited, such as one hour every other day.

Patients may be personally responsible for paying for:

  • the difference between what Medicare will pay and what the hospice service charges
  • treatments designed to cure a terminal illness
  • treatment or services not related to comfort care, and
  • room and board—except for temporary respite care.

Medicare generally covers a total of 210 days of hospice care, broken into two 90-day periods of benefits, followed by a 30-day period. Each of the periods may be extended, but only when a doctor recertifies that the patient's condition remains terminal.

Medicare Part A Premiums

Most people don't pay premiums for Part A, but if you didn't work for 10 years (40 quarters) in a job paying Medicare taxes, you may have to pay a monthly premium between $274 (if you have 30-39 work credits) and $499 (if you have fewer than 30 work credits).

If you are low-income and eligible for the Qualified Medicare Beneficiary (QMB) cost-reduction program, administered by your state's Medicaid program, it will pay for your Part A premium.

Updated December 9, 2022

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