The hospital insurance program is designed to help pay the bills when an insured person is hospitalized. The program also provides payments for required professional services in a skilled nursing facility (but not for custodial care) following a hospital stay, home health services, and hospice care.
Benefits under this program cover medically necessary care in hospitals and skilled nursing facilities, home health visits, and hospice care. Coverage also includes blood, after the first three pints, when the person is an inpatient at a hospital or skilled nursing facility during a covered stay.
There is a limit on how many days of hospital or skilled nursing care Medicare helps pay for in each benefit period. A benefit period begins the day a patient goes to a hospital or skilled nursing facility. It ends after a person has not received any hospital or skilled nursing care for 60 days in a row. There is no limit to the number of benefit periods a person can have.
Benefits are ordinarily paid only for services received in the United States or Canada. Hospital insurance also covers hospital stays in Mexico under very limited conditions.
What Medicare Part A Covers
- If a patient is hospitalized, Medicare will pay for all covered hospital services during the first 60 days of a benefit period except for a deductible. From the 61st through the 90th day, Medicare hospital insurance pays for all covered services except for a coinsurance charge. A lifetime reserve of 60 days may be used if a patient is in the hospital for more than 90 days in a benefit period; the patient pays a coinsurance charge for these additional days. Covered hospital services include almost all those ordinarily furnished by a hospital to its patients. (More information on specific services is available by calling 1-800-MEDICARE (1-800-633-4227) or by visiting medicare.gov.However, payments will not be made for private-duty nursing or personal comfort items. Inpatient psychiatric hospital services are covered, but there is a lifetime limitation of 190 days.
- Under certain conditions, the cost of skilled nursing care in a facility approved by Medicare for services of a professional level (not custodial care) is covered for the first 20 days in each benefit period plus up to 80 additional days with the patient paying a coinsurance charge for the 21st through the 100th day. These benefits are payable only if the patient was in a hospital for at least 3 days in a row, not counting the day of discharge, before transferring to a skilled nursing facility.
- Under certain conditions, Medicare pays the cost of medically necessary home health care services. This is limited to reasonable and necessary part-time or intermittent skilled nursing care and home health aide services as well as physical therapy, occupational therapy, and speech-language therapy which are ordered by a doctor. It also includes medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), medical supplies, and other services.
- Hospice care is a service provided to terminally-ill persons. It includes drugs for symptom control and pain relief, medical and support services from a Medicare-approved hospice, and other services not otherwise covered by Medicare.
Railroad employers and employees each pay hospital insurance taxes with their railroad retirement taxes. The hospital insurance tax on each is 1.45 percent on all earnings. An additional 0.9 percent in hospital insurance taxes (2.35 percent in total) applies to an individual's income exceeding $200,000, or $250,000 for a married couple filing a joint tax return.