Medicare Part A (hospital insurance) covered services

Part A premium: 

  • For most people, Part A is free.
  • If you have fewer than 30 working quarters of coverage, you pay $426/month.
  • For 30-39 working quarters of coverage, you pay $234/month.

Your benefit period for hospitalization and skilled nursing facility care:

  • It starts the first day you receive a Medicare-covered service as an inpatient in a qualified hospital.
    Note: Just because you're in a hospital does not mean you qualify as an inpatient.
  • It ends when you have been out of a hospital (or other facility that provides skilled nursing or rehab services) for 60 days in a row.
  • It also ends if you stay in a facility (other than a hospital) that provides nursing or rehab services, but don't receive any skilled care there for 60 days in a row.
  • If you enter a hospital again after 60 days, a new benefit period starts.

Get a printable PDF of Medicare Part A and B covered services chart (PDF, 110KB)

Services Benefit Medicare pays You pay

Hospitalization
Semi-private room and board, general nursing and other hospital services and supplies (Medicare payments based on benefit periods)

Note: Neither Medicare nor Medigap insurance pay for most nursing-home care.

First 60 days All but $1,216 $1,216 (For each benefit period) $0 coinsurance for each benefit period
61st to 90th day All but $304/day $304/day (Coinsurance per day for each benefit period)
91st to 150th day (60 reserve days may be used only once All but $608/day $608/day (Coinsurance per each "lifetime reserve day" after day 90 for each benefit period. Up to 60 days over your lifetime)
Beyond 150 days (Lifetime reserve days) Nothing All costs

Skilled nursing facility care
Semi-private room and board, skilled nursing and rehabilitative services and other services and supplies (Medicare payments based on benefit periods)

(Not custodial or long-term care)

Note: Neither Medicare nor Medigap insurance pay for most nursing home care.

First 20 days 100% of approved amount Nothing
Next 80 days All but $152/day Up to $152/day
Beyond 100 days Nothing All costs

Home health services
Part-time or intermittent skilled care or physical therapy, speech language pathology services, and/or continuing occupational therapy needs, home health aide services, durable medical equipment and supplies, and other services 

 

(A doctor or certain health care providers who work with a doctor, must see you face-to-face before a doctor can certify that you need home health services.)                                                                                 

Unlimited as long as you meet Medicare requirements for home health care benefits

100% of approved amount

80% of approved amount for durable medical equipment

Nothing for services

20% of approved amount for durable medical equipment

Hospice care
Pain relief, symptom management, medical, nursing and social services, drugs, certain durable medical equipment and other covered services such as spiritual and grief counseling

For as long as doctor certifies need All but limited costs for outpatient drugs and inpatient respite care Limited cost sharing for outpatient drugs and inpatient respite care

Blood
If the hospital gets blood from a blood bank at no charge, you won't have to pay for it or replace it. If hospital buys blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated by you or someone else.

When furnished by a hospital or skilled nursing facility during a covered stay

Note: The three-pint blood deductible (donated or paid for) may be met by inpatient (Part A) or outpatient (Part B) care and is required only once in a calendar year.

Unlimited during a benefit period if medically necessary All but first three pints per calendar year For first three pints

Updated 09/09/2014

See also

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