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What services are not covered under Medicare Part A?

Original Medicare, the federal insurance program included in the bill that President Lyndon B. Johnson signed into law in 1965, includes Part A and Part B.

Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, some home health care, and end-of-life hospice care.

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Part B covers doctors’ services, diagnostic screenings, lab tests, preventive services, outpatient care and some medical equipment and supplies, and transportation.

These two parts of Medicare can cover many of your health care costs, but they still leave gaps.

What hospital services won’t Part A pay for?

Part A covers a variety of hospital costs, including a semiprivate room and meals, general nursing services and drugs, supplies and hospital services that are part of your inpatient treatment. However, Part A doesn’t cover the following:

  • A private room in a hospital or skilled nursing center, unless it’s medically necessary
  • The first three pints of blood, unless the hospital gets it from a blood bank at no charge, you arrange to replace it through donating your own or somebody else’s blood, or you have additional insurance such as Medigap that covers this cost
  • Hiring your own nurse, also called private-duty nursing care
  • Personal items such as razors or slipper socks, unless provided to all patients at no extra charge
  • A television or telephone in your room if either is a separate charge

What hospital costs does Part B cover instead?

Some hospital-related services that you might expect Part A to pay for are instead covered through Medicare Part B. They include:

  • Physicians’ services, including anesthetists, hospitalists, surgeons and other doctors in a medical center or a skilled nursing facility. Hospitalists, doctors who don’t see patients in an office-based practice but instead deliver care in a hospital, are a growing specialty. By 2018, more than three-quarters of hospitalized Medicare beneficiaries had received at least some care from a hospitalist, compared with fewer than half 10 years earlier, according to a study released in March 2022.
  • Any care you receive in the hospital if you are “under observation” rather than officially admitted as a patient. This holds true even if you are in a hospital bed and receiving the same kind of care as any other patient. This can affect your out-of-pocket costs because Part A and Part B have different deductibles and copayments.

Keep in mind

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Three-day hospitalization rule. Part A covers short-term stays in a skilled nursing facility or rehab center after being discharged from the hospital. But you can qualify for this coverage only if you first were formally admitted to the hospital as an inpatient for at least three consecutive days.

If you qualify for skilled nursing facility coverage, you pay:

  • Nothing for days 1 to 20
  • Up to $194.50 per day in 2022 ($200 per day in 2023) for days 21 to 100.
  • All costs for days 101 and beyond

Must be an inpatient. If you were in the hospital “under observation” rather than admitted as an inpatient, you do not qualify for Medicare’s skilled nursing coverage.

Medicare Part A, or any part of Medicare, doesn’t cover long-term care in a nursing home or assisted living facility. Medicare will cover your medical needs, as it would no matter where you live. But it does not pay for room and board at these facilities or for help with everyday activities such as bathing, dressing, eating or using the bathroom (also called “custodial care”) if that is the only care that you need.

Updated December 15, 2022


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