Part A Part A, also known as hospital insurance, is the part of Medicare that covers most medically necessary hospital inpatient care, skilled nursing facility (SNF) care, home health care, and hospice care. covers medically necessary Medically necessary refers to procedures, services, or equipment that meet accepted medical standards and are necessary for the diagnosis and treatment of a medical condition. inpatient hospital care, which is care that you receive as a formally admitted hospital inpatient. You must be formally admitted into the hospital by a physician in order for your care to be considered inpatient hospital care. You may face different costs if you are a hospital outpatient. If you are a hospital inpatient, Part A covers:
- A semi-private room and meals
- Note: A semi-private room is a hospital room that contains two or more beds (generally just two), usually with a curtain separating the beds
- General nursing care
- Medically necessary medications
- Other hospital services and supplies
Medicare does not cover:
- Private duty nursing Private duty nursing is direct, comprehensive care on a continuous or live-in basis. Medicare does not cover private duty nursing.
- A private room (unless medically necessary or if it is the only room available)
- Personal care Personal care, also known as unskilled care, is assistance with activities of daily living. Providers of personal care (home health aides) are not required to undergo medical training. Medicare only covers personal care if you are homebound and receiving skilled care. items (such as razors or socks)
- A television or telephone in your room
After meeting your Part A deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. , Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. pays in full for the first 60 days of your benefit period The benefit period is the amount of time during which Medicare pays for hospital and skilled nursing facility (SNF) services. A benefit period begins the day you are admitted to a hospital as an inpatient, or to a SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. With each new benefit period, you pay a new deductible. Your coinsurance is determined by the number of days you have been in the facility during each benefit period. . After day 60, you will pay a daily hospital coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. . Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. continues to cover any outpatient provider services you receive while in the hospital. You usually owe a separate 20% coinsurance for these services.