Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits.

Cost: Most people don't have to pay a monthly payment, called a premium, for Part A. This is because they or a spouse paid Medicare taxes while they were working. If you (or your spouse) didn't pay Medicare taxes while you worked and you are age 65 or older, you may be able to buy Part A.

If you aren't sure if you have Part A, look on your red, white, and blue Medicare card. If you have Part A, "Hospital (Part A)" is printed on your card. You can call Social Security at 1-800-772-1213, or visit your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-800-808-0772.

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services as long as you need part-time or intermittent skilled services and as long as you’re “homebound,” which means:

• You have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury.
• Leaving your home isn’t recommended because of your condition.
• You’re normally unable to leave your home because it’s a major effort.

Covered home health services include: 

• Medically necessary part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide care (only if you’re also getting skilled nursing care at the same time)
• Injectable osteoporosis drugs for women
• Durable medical equipment
• Medical supplies for use at home

Usually, a home health care agency coordinates the services your doctor or allowed practitioner (including a nurse practitioner, a clinical nurse specialist, and physician assistant) orders for you. The home health agency caring for you must be Medicare-certified.

Medicare doesn't pay for:

• 24-hour-a-day care at your home
• Meals delivered to your home
• Homemaker services (like shopping and cleaning) that aren’t related to your care plan
• Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need

Who's eligible?

All people with Part A and/or Part B who meet all of these conditions are covered:

• You must be under the care of a doctor or allowed practitioner, and you must be getting services under a plan of care created and reviewed regularly by a doctor or allowed practitioner.
• You must need, and a doctor or allowed practitioner must certify that you need, one or more of these:
  • Intermittent skilled nursing care (other than drawing blood).
  • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
• You must be homebound, and a doctor or allowed practitioner must certify that you're homebound .

You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care . You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Your costs in Original Medicare

• $0 for covered home health care services.
• After you meet the Part B deductible, 20% of the Medicare-Approved Amount for Medicare-covered medical equipment.

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren't covered by Medicare, and how much you'll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice" (ABN) before giving you services and supplies that Medicare doesn't cover.

Note

If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency, or you, may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements.

Your Medicare home health services benefits aren't changing and your access to home health services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

You qualify for hospice care if you have Medicare Part A (Hospital Insurance)and meet all of these conditions:

• Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).
• You accept comfort care (palliative care) instead of care to cure your illness.
• You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

You can usually get Medicare-certified hospice care in your home or other facility where you live, like a nursing home. You can also get hospice care in an inpatient hospice facility. 

Your costs in Original Medicare

• You pay nothing for hospice care.
• You pay a copaymentof up to $5 for each prescription for outpatient drugs for pain and symptom management. In the rare case the hospice benefit doesn't cover your drug, your hospice provider should contact your plan to see if Part D covers it. The hospice provider will inform you if any drugs or services aren’t covered, and if you’ll be required to pay for them.
• You may pay 5% of the Medicare-Approved Amountfor inpatient respite care. Your copay can’t exceed the inpatient hospital deductible for the year.
• Original Medicare will still pay for covered benefits for any health problems that aren't part of your terminal illness and related conditions, but this is unusual. Once you choose hospice care, your hospice benefit will usually cover everything you need.
• You may have to pay for room and board if you live in a facility (like a nursing home) and choose to get hospice care.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• If your doctor accepts assignment
• The type of facility
• Where you get your test, item, or service

What it is

Depending on your terminal illness and related conditions, your hospice team will create a plan of care that can include any or all of these services:

• Doctors' services.
• Nursing and medical services.
• Durable medical equipment for pain relief and symptom management.
• Medical supplies, like bandages or catheters.
• Drugs for pain and symptom management.
• Aide and homemaker services.
• Physical therapy services.
• Occupational therapy services.
• Speech-language pathology services.
• Social services.
• Dietary counseling.
• Spiritual and grief counseling for you and your family.
• Short-term inpatient care for pain and symptom management. 
• Inpatient respite care , which is care you get in a Medicare-approved facility (like an inpatient facility, hospital, or nursing home), so that your usual caregiver (like a family member or friend) can rest. Your hospice provider will arrange this for you. You can stay up to 5 days each time you get respite care. You can get respite care more than once, but only on an occasional basis.
• Any other services Medicare covers to manage your pain and other symptoms related to your terminal illness and related conditions, as your hospice team recommends.

Things to know

Only your hospice doctor and your regular doctor (if you have one) can certify that you’re terminally ill and have a life expectancy of 6 months or less. After 6 months, you can continue to get hospice care as long as the hospice medical director or hospice doctor recertifies (at a face-to-face meeting) that you’re still terminally ill. 

Medicare won't cover any of these once your hospice benefit starts:

• Treatment intended to cure your terminal illness and/or related conditions. Talk with your doctor if you're thinking about getting treatment to cure your illness. As a hospice patient, you always have the right to stop hospice care at any time.
• Prescription drugs to cure your illness (rather than for symptom control or pain relief).
• Care from any hospice provider that wasn't set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness must be given by or arranged by the hospice team. You can't get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you've chosen him or her to be the attending medical professional who helps supervise your hospice care.
• Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
• Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it's either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

Contact your hospice team before you get any of these services or you might have to pay the entire cost.

Medicare Part A (Hospital Insurance) covers inpatient hospital care if you meet both of these conditions:

• You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury
• The hospital accepts Medicare

Your costs in Original Medicare

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

You pay this for each benefit period:

• $1,600 deductible
• Days 1–60: $0
• Days 61–90: A $400 copayment each day 
• Days 91 and beyond: An $800 copayment per each "lifetime reserve day" after day 90 (up to 60 days over your lifetime) 
• Each day after lifetime reserve days: All costs

Hospitals are now required to make public the standard charges for all of their items and services (including the standard charges negotiated by Medicare Advantage Plans) to help you make more informed decisions about your care.

What it is

Medicare-covered inpatient hospital services include:

• Semi-private rooms
• Meals
• General nursing
• Drugs (including methadone to treat an opioid use disorder)
• Other hospital services and supplies as part of your inpatient treatment

Medicare doesn't cover:

• Private-duty nursing
• Private room (unless medically necessary)
• Television or phone in your room (if there's a separate charge for these items)
• Personal care items (like razors or slipper socks)

Things to know

Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

Inpatient hospital care includes care you get in:

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Inpatient psychiatric facilities
• Long-term care hospitals

It also includes inpatient care you get as part of a qualifying clinical research study.

If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.

If you or someone you know is in crisis, call or text 988 or chat 988lifeline.org.

Call 911 if you're in immediate medical crisis.

Medicare Part A (Hospital Insurance)covers mental health care services you get when you're admitted as a hospital patient. Medicare Part B (Medical Insurance)covers the services you get from a doctor or other health care provider while you’re in the hospital.

Your costs in Original Medicare

You pay this for each benefit period: 

• $1,600 deductible
• Days 1–60: $0 per day
• Days 61–90: A $400 copayment per day 
• Days 91 and beyond: An $800 copayment per each "lifetime reserve day " after day 90 (up to a maximum of 60 reserve days over your lifetime) 
• Each day after the lifetime reserve days: All costs
• 20% of the Medicare-Approved Amount  for mental health services you get from doctors and other health care providers while you're a hospital inpatient.

What it is

Mental health care services help diagnose and treat people with mental health disorders, like depression and anxiety.

Things to know

You can get these services either in a general hospital or a psychiatric hospital (a facility that only cares for people with mental health disorders). There’s no limit to the number of benefit periods you can have, whether you’re getting mental health care in a general or psychiatric hospital.

However, if you're in a psychiatric hospital (instead of a general hospital), Part A only pays for up to 190 days of inpatient psychiatric hospital services during your lifetime.

Medicare doesn't cover:

• Private duty nursing
• A phone or television in your room
• Personal items, like toothpaste, socks, or razors
• A private room, unlessmedically necessary

Medicare Part A (Hospital Insurance) covers medically necessary care you get in an inpatient rehabilitation facility or unit (sometimes called an inpatient “rehab” facility, IRF, acute care rehabilitation center, or rehabilitation hospital). Your doctor must certify that you have a medical condition that requires intensive rehabilitation, continued medical supervision, and coordinated care that comes from your doctors and therapists working together.

Your costs in Original Medicare

You pay this for each benefit period :

• Days 1-60: $1,600 deductible*
• Days 61-90: A $400 copayment each day 
• Days 91 and beyond: An $800 copayment per each “lifetime reserve day ” after day 90 (up to a maximum of 60 reserve days over your lifetime)
• Each day after the lifetime reserve days: All costs

*You don’t have to pay a deductible for inpatient rehabilitation care if you were already charged a deductible for care you got in a prior hospitalization within the same benefit period. This is because your benefit period starts on day one of your prior hospital stay, and that stay counts towards your deductible. For example, you won’t have to pay a deductible for inpatient rehabilitation care if:

• You’re transferred to an inpatient rehabilitation facility directly from an acute care hospital
• You’re admitted to an inpatient rehabilitation facility within 60 days of being discharged from a hospital

What it is

Inpatient rehabilitation can help if you’re recovering from a serious surgery, illness, or injury and need an intensive rehabilitation therapy program, physician supervision, and coordinated care from your doctors and therapists.

Medicare-covered inpatient rehabilitation care includes:

• Rehabilitation services, including physical therapy, occupational therapy, and speech-language pathology
• A semi-private room
• Meals
• Nursing services
• Prescription drugs
• Other hospital services and supplies

Medicare doesn’t cover:

• Private duty nursing
• A phone or television in your room (if there’s a separate charge for these items)
• Personal items, like toothpaste, socks, or razors (except when a hospital gives them as part of your hospital admission pack)
• A private room, unless medically necessary

Things to know

Medicare Part B (Medical Insurance) covers doctors’ services you get while you’re in an inpatient rehabilitation facility.

Medicare Part A (Hospital Insurance) covers skilled nursing facility care  for a limited time (on a short-term basis) if all of these conditions apply:

• You have Part A and have days left in your benefit period to use.
• You have a qualifying inpatient hospital stay. 
• Your doctor has decided that you need daily skilled care. You must get the care from, or under the supervision of, skilled nursing or therapy staff.
• You get these skilled services in a Medicare-certified SNF.
• You need these skilled services for a medical condition that’s either:
  • A hospital-related medical condition. 
  • A condition that started while you were getting care in the SNF for a hospital-related medical condition.

Your costs in Original Medicare

You pay this for each benefit period:

• Days 1 - 20: $0 coinsurance
• Days 21 - 100: Up to $200 coinsurance per day
• Days 101 and beyond: All costs

There's a 100-day limit of Part A SNF coverage in each benefit period.

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

What it is

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.

Medicare-covered services in a skilled nursing facility include, but aren't limited to:

• A semi-private room (a room you share with other patients)
• Meals
• Skilled nursing care
• Physical therapy (if needed to meet your health goal)
• Occupational therapy (if needed to meet your health goal)
• Speech-language pathology services (if they're needed to meet your health goal)
• Medical social services
• Medications
• Medical supplies and equipment used in the facility
• Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF
• Dietary counseling