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Understand Medicare

Medicare Part A:
Hospital Coverage

Medicare Part A is coverage for your inpatient hospital care. You usually don’t pay a monthly premium for Medicare Part A if you or your spouse paid Medicare taxes while working.* Here are the types of hospital care that qualify for coverage.

 

Inpatient Hospital Care

This is the care you get in acute care hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care. Coverage includes hospital services, semi-private rooms, meals, general nursing, and medications.

 
PART A IN 2017*
YOU PAY
Days 1 - 60
Eligible care is covered in full after annual deductible of $1,316 of each benefit period**
Days 61 - 90
Coinsurance of $329 per day of each benefit period
Days 91 - 150
Coinsurance of $658 per each "lifetime reserve day***"
(up to 60 reserve days can be used throughout your lifetime)
Days 151+
All costs for each day after you use all lifetime reserve days

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Skilled Nursing Facility (SNF) Care

This is care provided in a skilled nursing facility under certain conditions, for a limited time. Medicare-covered services include skilled nursing care, semi-private room, meals, physical and occupational therapy, medical social services, medications, ambulance transportation, and dietary counseling.

 
PART A IN 2017*
YOU PAY
Days 1 - 20
$0 for first 20 days of each benefit period
Days 21- 100
Coinsurance of $164.50 per day of each benefit period
Days 101+
All costs for each day after day 100 in a benefit period

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Nursing Home Care

Care provided at a nursing home when skilled nursing care is medically necessary (like changing sterile dressings). This care is only covered as long as custodial care isn’t the only care you need (like help with bathing or dressing).

Hospice Care

Care usually provided in your home, including drugs to control symptoms and pain, but not for treatment intended to cure a terminal illness or related conditions. You pay $0 for eligible hospice care. A $5 copay applies for outpatient prescription drugs.

Home Health Services

Care provided for eligible home health services like intermittent skilled nursing care, physical therapy, and speech-language pathology services. You pay $0 for eligible home health care services.

* Part A premium is waived if you or your spouse worked 10 years or 40 quarters.
** A benefit period begins the day you’re admitted as an inpatient in a hospital or SNF and ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. A 3-day prior inpatient hospital stay is required for coverage of SNF days.
*** A total of 60 lifetime reserve days can be used for additional hospital days during your lifetime.

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Y0088_4946 CMS Pending
Last Updated: October 2017