Medicare Part A (hospital insurance) covered services

Part A premium: 

  • If you have fewer than 30 working quarters of coverage, you pay $441/month.
  • For 30-39 working quarters of coverage, you pay $243/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, 196KB)

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 $1,184 $1,184
61st to 90th day All but $296/day $296/day
91st to 150th day (60 reserve days may be used only once All but $592/day $592/day
Beyond 150 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)

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 $148/day Up to $148/day
Beyond 100 days Nothing All costs
Home health care
Part-time or intermittent skilled care, home health aide services, durable medical equipment and supplies, and other 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 and support services for the terminally ill

 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
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 01/18/2013

See also

Need more help?

  • Our Statewide Health Insurance Benefits Advisors (SHIBA) offers free, unbiased Medicare counseling.
  • Call SHIBA at 800-562-6900
  • Email us