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Inpatient or hospital insurance is an important part of Original Medicare.
Medicare Part A benefits include inpatient care at a hospital, nursing facility, or hospice
Your doctor must formally order the hospital to admit you as an inpatient in order for Part A to cover your stay
Medicare beneficiaries usually pay no premium cost for Part A, but there is a deductible and coinsurance
Part A and Part B of Medicare work together
Medicare Part A is hospital insurance. One of four parts of Medicare, Part A broadly covers inpatient care at hospitals, skilled nursing facilities, hospice, and certain home health services. An inpatient is someone whose doctor formally admitted them overnight. (We’ll discuss this more later.) Medicare Part A, when combined with Medicare Part B (which covers outpatient insurance) is known as Original Medicare.
Much of the care you receive through Medicare Part A is free, like home health services and hospice care. But you will have to pay a deductible for overnight stays at the hospital, and if you have to stay more than 60 days, you’ll also be required to pay coinsurance.
If you are are eligible to receive Social Security benefits — meaning that were employed at least ten years and paid payroll taxes — then Part A has no premium. Otherwise you’ll have to pay a monthly premium.
But before we get started, you can refresh yourself on Medicare here. This federal health insurance program is designed to cover Americans 65 and older and some younger Americans with permanent disabilities. Read about Part C and Part D here.
In this article:
Medicare Part A covers care you receive when you stay at the hospital as an inpatient or skilled nursing facility. This includes:
Generally, Medicare will cover less of the costs the longer you stay, and after a certain period of days you’ll have to cover everything. (We’ll discuss the costs later.)
Where you can receive Medicare Part A coverage is roughly broken down into the following categories:
If you are staying at the hospital, you’ll have to make sure you're an inpatient — that a doctor must order you to stay in the hospital for at least three days (two “midnights”). (The hospital or facility must accept Medicare.) If you have outpatient status and are receiving services without a direct recommendation by your doctor, Medicare will not cover the bills.
For example, if you go to the emergency room on your own and spend the night there, you will be considered an outpatient, unless your doctor notifies the hospital that you should be formally admitted to stay overnight as an inpatient.
Medicare Part A covers inpatient care at any of the following:
After you are discharged from a hospital stay, you may still need care that you can’t give yourself, like an intravenous injection. If that’s the case, your doctor might order a stay at a skilled nursing facility where a skilled professional can administer your treatment and provide you with the proper medication.
Medicare will cover your stay at the nursing facilities after your qualifying hospital stay and if you have a legitimate medical condition. Medicare will not cover a nursing home stay if it is simply for personal care, like bathing and getting dressed (sometimes called custodial care).
Part A also covers the following services at nursing facilities when medically necessary:
Terminally ill patients can get hospice care covered by Medicaid. You need a life expectancy of six months or less and if you choose to accept hospice, which means receiving palliative care in lieu of medical treatments.
Medicare can cover the cost of home health care — like intermittent skilled nursing care or home health aides — in specific circumstances. Primarily, you must have recently had prior inpatient hospitalization and be homebound (unable to leave your home for medical reasons). You’ll need written confirmation from your doctor after having a face-to-face meeting.
If you don’t qualify for home health care coverage through Medicare Part A, you might be able to get covered through Part B. (In fact, it might be preferable since it is typically less costly when covered under Part B.)
While this part of Medicare covers stays in a nursing home, it will only do so if it is medically necessary. If you need non-medical long-term care, such as for chronic illness or disability, you’ll have to consider other options like long-term care insurance. If you meet the income and asset requirements for Medicaid you can also get long term care coverage.
Medicare Part A covers the cost of an inpatient hospital stay, but fees charged by a doctor or specialist physician will be covered by Part B.
Medicare Part A does not cover the following at any hospital or facility:
You can see what hospitals accept Medicare and what specific services are covered on Medicare.gov. You can also talk to your doctor or health care provider about whether a service or treatment they are recommending is traditionally covered by Medicare.
Medicare Part B covers outpatient and preventative screenings and services. Think of it as doctor insurance. You can check your Medicare card to see if you have Part B; it will be designated with the word “MEDICAL.” The following chart broadly illustrates what type of services each part covers.
Medicare Part A vs. Medicare Part B
|Covered benefit||Part A||Part B|
|ER visits||Not covered||Covered|
|Hospital stays||Covered||Not covered|
|Nursing home||Covered||Not covered|
|Home health care||Covered||Covered|
|Doctors visits||Not covered||Covered|
|Shots or vaccines||Not covered||Covered|
|Ambulance services||Not covered||Covered|
|Long-term care (non-medical)||Not covered||Not covered|
|Prescription drug plan||Not covered||Not covered|
Medicare Part A and Medicare Part B work in tandem. You enroll in them, or opt for Medicare Advantage plans through Part C. Advantage plans are provided by private insurance companies that approved by the Medicare program. Lastly, prescription drug coverage is provided by Medicare Part D.
If you’re getting retirement benefits or are eligible for retirement benefits, Medicare Part A has a $0 monthly premium payment. The same rule applies if you’re under 65 years old and have been claiming federal disability benefits for at least 24 months, or if you’ve been diagnosed with end-stage renal disease or Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS). Americans who are eligible for Medicare, but not other federal benefits, can still get coverage for a monthly premium up to $437.
Medicare Part A comes with a $1,364 deductible — the amount you must pay in out-of-pocket expenses before coverage kicks in — for each benefit period. A benefit period begins the day you’re admitted to a hospital and ends once you haven’t received in-hospital care for 60 days.
Medicare recipients also pay coinsurance or a portion of the costs for a covered stay or visit. The coinsurance amount varies, depending on which benefit day you’re on (how long you’re in the hospital) and also the type of service — inpatient hospital stays have different costs than hospice care, for example. (We’ll go into specific examples next.)
If you anticipate needing more hospital coverage than Medicare A will pay for, you can get Medigap, or Medicare Supplement Insurance. Offered by private insurers, a Medicare supplement plan can provide additional coverage after you have used all your traditional Medicare benefits.
Here’s the basic breakdown for a stay at an in-patient hospital:
You get 60 “lifetime reserve days” while on Medicare. These are extra days you can apply toward your qualified stay. After the lifetime reserve days are used, you’ll have to pay for all costs.
Coverage for inpatient psychiatric care is capped at a 190 days in your lifetime.
Hospice care is free. There may be a small copayment of $5 for drugs or pain relief medication. (However, a Medicare prescription drug plan may end up covering the costs.)
Learn more about the total cost of Medicare here.
If you’re on federal retirement benefits, you get automatically enrolled in Medicare Part A and Medicare Part B on the first day of the month you turn 65.
Otherwise, you will need to sign up yourself during your initial enrollment period, which starts three months before you turn 65. (Note: the enrollment period for Medicare differs from the one for individual plans you buy on the Obamacare marketplace.)
You can apply by visiting your local Social Security office, calling Medicare at 1-800-772-1213, or simply filling out an application online at the Social Security Administration website. Here is a step-by-step guide to applying for Medicare.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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