Part A, or the Hospital Insurance part of Medicare, covers your treatment while in a hospital facility. Since it is impossible to include all there is to know about Part A coverage, the following is for general information only.
As an Inpatient in a Hospital
- semi-private rooms
- routine nursing care
- drugs used for inpatient treatment
- other hospital services and supplies
Hospital facilities include:
- acute care hospitals
- critical access hospitals
- inpatient rehab facilities
- long-term care hospitals
- mental health care
- inpatient care when participating in a qualified
Part A will not cover private nurses, private rooms not considered necessary for your treatment, television or phone as a separate charge, or items used for personal care such as razors.
To receive Part A benefits, the hospital must accept Medicare assignment and your doctor must order your stay because your treatment needs require it. Also, you must stay 2 or more “midnights,” you must be officially admitted by the hospital, and their Utilization Review Committee must approve your stay.
You will have to pay the applicable annual deductibles. You may also be responsible for costs for services Medicare doesn’t cover, including services ordered by your doctor more often than allowed.
As an Inpatient in a Skilled Nursing Facility
Part A will also cover inpatient stays in Skilled Nursing Facilities for a period of time depending upon certain factors. The following lists most, but not all, of the services that might be paid.
- Semi-private room
- Skilled nursing care
- Physical and occupational therapy if medically necessary
- Speech therapy, if medically necessary
- Medically necessary social services
- Medical supplies and equipment
- Ambulance service (must be medically necessary)
- Dietary counseling
To be paid, admission must follow a qualifying stay in the hospital and you must have days remaining in your benefit period. It must be a Medicare certified Skilled Nursing Facility, and your stay must be for a hospital-related condition or for one that occurred while in the Skilled Nursing Facility for a qualified stay.
As an Inpatient in a Long-term Care Hospital (LTCH)
Long-term care hospitals treat those with multiple serious medical conditions who may improve with longer treatment and be able to return home. Usually the costs are no more than those for an acute care hospital. However, a second deductible could be applied unless it has been no more than 60 days since you were discharged from an acute care hospital.
There is a lot to learn about your Medicare benefits, but a conversation with an insurance specialist can help you make the right insurance decision for your needs.