For Consumers

What Medicare Part A (hospital insurance) covers

In general, Part A covers:

Find out if Medicare covers your item, service or supply (www.medicare.gov).

How much is covered?

Services

Benefit

Medicare pays

You pay in 2018

Hospitalization
Semi-private room and board, general nursing and other hospital services and supplies (Medicare payments based on benefit periods) (See comments 1 & 2)

First 60 days

All but $1,316

$1,340

 

61st to 90th day

All but $329/day

$335/day

 

91st to 150th day (60 reserve days may be used only once

All but $658/day

$670/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) (See comments 1 & 2)

First 20 days

100% of approved amount

Nothing

 

Days 21-100

All but $164/day

Up to $167.50/day

 

101 days and beyond

Nothing

All costs

Home health care
Part-time or intermittent skilled care, home health aide services, durable medical equipment and supplies and other services
Note: Doctor must order care and a Medicare-certified home health agency must provide it

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 - meaning you have a life expectancy of six months or less

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

Unlimited during a benefit period if medically necessary

All but first three pints per calendar year

For first three pints

1 - Neither Medicare nor Medigap insurance pay for most nursing home care (See Medicare & You 2018 booklet, page 60). 

2 - A benefit period starts the first day you receive a Medicare-covered service in a qualified hospital.  It ends when you’ve 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 skilled nursing or rehab services, but do not 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.

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