Part A helps pay for inpatient stays in hospitals and skilled nursing facilities, some home care, and end-of-life hospice care.
Part B covers doctor and outpatient services. Part A and Part B, both included in the bill that President Lyndon B. Johnson signed into law in 1965, are known as original Medicare.
Part C, also known as Medicare Advantage, is a private health insurance alternative to federally run original Medicare, enacted as the Medicare+Choice program in 1997 and changing to Medicare Advantage in 2003. If you choose to get coverage from a Medicare Advantage plan, you still need to sign up for Medicare Parts A and B.
Part D is prescription drug coverage, which you can get from a stand-alone private policy or a Medicare Advantage plan.
The following services are included.
Hospital services coverage. Medicare Part A helps pay for many of your expenses if you’re admitted as an inpatient to a hospital that accepts Medicare, such as:
You have no copayment for the first 60 days of an inpatient hospital stay for each benefit period. You pay a portion of the cost after that, called Part A coinsurance. A benefit period begins the day you are admitted to a hospital as an inpatient or become a patient in a skilled nursing facility and ends when you’ve been out of the hospital or skilled nursing facility for 60 days in a row.
Home health care coverage. Part A covers some part-time skilled home care for people who are homebound and meet other requirements. A doctor must certify that you need intermittent skilled nursing care, physical therapy, continued occupational therapy or speech-language pathology services. A Medicare-approved home health agency must provide the care.
Hospice care coverage. Medicare Part A covers hospice care for people who are terminally ill. Your doctor must certify that you have a life expectancy of six months or less. Hospice provides comfort care, also known as palliative care, rather than medical treatment to cure your illness.
You may receive hospice care in your home, an inpatient hospice center, a nursing home or other facility. You may have to pay room and board if you live in a place that is not a hospice facility, such as a nursing home.
Skilled nursing facility coverage. Part A covers the first 20 days in a Medicare-certified skilled nursing facility, which provides specialized nursing care and rehabilitation after being hospitalized. You generally need to have been an inpatient in a hospital for at least three days to qualify, and your doctor has to certify that you need daily skilled care from or under the supervision of skilled nursing or therapy staff.
Coverage in a skilled nursing facility may include:
Medicare Part A doesn’t cover all hospital-related services.
Even though Medicare Part A covers many of your expenses if you are hospitalized or qualify for skilled nursing facility coverage, you may still have some out-of-pocket costs.
Premiums. Most people don’t pay premiums for Medicare Part A because they or their spouse had Medicare taxes deducted from their paychecks for at least 40 quarters of work, the equivalent of 10 years. You’ll pay $274 a month in 2022 if you or your spouse paid Medicare taxes for 30 to 39 quarters, or $499 a month if you paid Medicare taxes for fewer than 30 quarters.
Deductible. You must pay a deductible before Part A coverage begins. In 2022, the Part A deductible is $1,556 per benefit period.
Copayments or coinsurance. This is the portion of the cost that you pay after you’ve met your deductible. Part A has no copay for hospital stays of up to 60 days in one benefit period. In 2022, copays for a longer stay may include:
Copays for skilled nursing facility stays in 2022
If you’re receiving hospice care, you may have a copayment of up to $5 per prescription for pain and symptom management. You may also pay 5 percent of the cost of inpatient respite care, such as a short-term stay in a nursing home to give your caregiver a break.
You can buy Medicare supplement insurance, known as Medigap, to cover the deductible and many of these out-of-pocket costs.
If you choose to get coverage through a private Medicare Advantage plan, you will receive at least as much coverage as original Medicare, but you may have different out-of-pocket costs. For example, a Medicare Advantage plan may have a daily copayment for the first few days in the hospital, such as $325 for each of the first five days as a hospital inpatient, rather than the Part A deductible.
You may also have to use certain in-network hospitals or facilities to receive coverage. Or if you use out-of-network facilities, you may have to pay more, depending on the type of Medicare Advantage plan.
Updated July 15, 2022
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