Learn About Medicare Part A and B Coverage

Understanding Medicare Part A: Hospital Insurance Coverage

Medicare Part A is the hospital insurance portion of the Medicare program. This guide explains what Part A covers and how it works. Part A helps pay for inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. According to the Centers for Medicare & Medicaid Services, approximately 65 million people were enrolled in Medicare in 2023, with the vast majority having Part A coverage.

Part A covers inpatient hospital stays when you are admitted to a hospital for treatment. This means staying overnight in a hospital bed under a doctor's care. If you go to a hospital's emergency room but are not admitted as an inpatient, Part A does not cover the visit. However, if the emergency room visit leads to admission as an inpatient, Part A will cover the hospital stay. The coverage includes semiprivate rooms, meals, nursing care, medications given during your hospital stay, and lab tests performed at the hospital.

Part A also covers skilled nursing facility care, but only under certain conditions. This applies when you need skilled care after a hospital stay of at least three days. You must be admitted to the skilled nursing facility within 30 days of leaving the hospital, and a doctor must determine the care is medically necessary. Part A covers up to 100 days per benefit period. The first 20 days are fully covered, and days 21 through 100 have a daily coinsurance amount that you would pay.

Hospice care is another service covered by Part A. This applies when a doctor certifies that you have a terminal illness and have six months or less to live. Part A covers doctor services, nursing care, medications related to your illness, medical equipment and supplies, and counseling services. Hospice focuses on comfort and quality of life rather than curing the illness.

Part A also covers some home health services when specific conditions are met. You must be homebound, meaning you cannot leave home without considerable difficulty, and a doctor must order home health care. A nurse or therapist visits your home to provide care. Home health visits for skilled nursing, physical therapy, occupational therapy, and speech-language pathology services may be covered. Home health aide services may also be covered if skilled care is being provided.

Practical Takeaway: When reviewing Part A coverage, focus on understanding the three main situations: inpatient hospital stays, skilled nursing facility care after hospitalization, and home health services ordered by your doctor. Knowing these distinctions helps you understand what costs Medicare Part A will and will not cover.

Part A Cost Structure: Deductibles and Coinsurance

Medicare Part A has specific costs you may pay, including a deductible and coinsurance amounts. Understanding these costs helps you plan for healthcare expenses. For 2024, the Part A inpatient hospital deductible is $1,632 per benefit period. This is the amount you pay before Part A begins to cover costs. A benefit period starts the day you are admitted to a hospital and ends 60 days after you leave the hospital without receiving skilled care.

After you pay the deductible, Part A covers most inpatient hospital costs for the first 60 days of each benefit period. From days 61 through 90, you pay a daily coinsurance amount. For 2024, this daily coinsurance is $408 per day. Beyond 90 days in a single benefit period, Medicare provides what is called a "lifetime reserve" of 60 additional days. During these reserve days, you pay $816 per day in 2024. These reserve days can only be used once in your lifetime.

For skilled nursing facility care, you pay nothing for the first 20 days of each benefit period after you meet the Part A deductible. From days 21 through 100, you pay a daily coinsurance amount of $204 per day in 2024. After 100 days in a benefit period, Part A does not cover skilled nursing facility care, and you pay all costs yourself.

Hospice care has a different cost structure. You typically pay nothing for hospice services covered by Part A. However, you may pay up to $5 for prescription medications and up to 5% of the Medicare-approved amount for inpatient respite care. Respite care means a short stay in a facility to give your caregiver a break.

Home health services covered by Part A have no deductible or coinsurance. You pay nothing for covered home health services as long as the services meet the requirements. However, if Part A does not cover certain equipment or supplies, you may be responsible for those costs.

Practical Takeaway: Before entering a hospital or skilled nursing facility, understanding the potential costs you may face helps with financial planning. The deductible applies per benefit period, not per year, which is different from many insurance plans people are familiar with. Tracking when your benefit period begins and ends is important for understanding your costs.

What Medicare Part B Covers: Medical Services and Supplies

Medicare Part B is medical insurance that covers services and supplies from doctors and other healthcare providers. Part B is optional, though most people who are enrolled in Medicare also have Part B coverage. Part B covers services such as doctor visits, outpatient hospital care, medical equipment, and preventive services. According to Medicare data, about 96 percent of Medicare beneficiaries have Part B coverage.

Part B covers visits to your doctor's office for various reasons, whether for routine checkups, treatment of illness, or management of ongoing health conditions. This includes primary care doctors, specialists, and other healthcare providers. Part B also covers outpatient hospital services, which means hospital care when you are not admitted as an inpatient overnight. Examples include emergency room visits that do not result in admission, observation stays, and outpatient surgery.

Diagnostic and therapeutic services are covered by Part B. These include X-rays, CT scans, ultrasounds, lab work, and electrocardiograms. Part B also covers physical therapy, occupational therapy, and speech-language pathology when ordered by your doctor. Mental health services, including visits with psychiatrists and psychologists, are covered. This represents a significant expansion of coverage compared to earlier years of the Medicare program.

Part B covers durable medical equipment (DME) such as wheelchairs, walkers, oxygen equipment, and hospital beds. Your doctor must order the equipment, and it must be used in your home. Part B also covers prosthetics and orthotics, which are artificial body parts and braces. Diabetic testing supplies such as glucose monitors and test strips are covered under Part B.

Part B includes coverage for preventive services designed to detect disease early or prevent disease altogether. These services are covered with no deductible and no coinsurance or copayment when you see a participating provider. Preventive services covered by Part B include the annual wellness visit, screenings for cancer, heart disease, and diabetes, and vaccinations for influenza, pneumococcal disease, and other conditions.

Practical Takeaway: Part B coverage is broader than many people realize, extending beyond doctor visits to include diagnostic testing, therapy services, and preventive care. Reviewing what Part B covers can help you understand what out-of-pocket costs you might face and whether additional coverage might be beneficial for your situation.

Part B Costs: Premiums, Deductibles, and Coinsurance

Medicare Part B requires you to pay a monthly premium, an annual deductible, and coinsurance for most services. These costs vary based on your income and when you enroll in Part B. For 2024, the standard Part B monthly premium is $174.70. However, if your income is higher, you may pay an income-related monthly adjustment amount (IRMAA), which means a higher premium. People with lower incomes may receive subsidies that reduce their Part B costs through programs outside of Medicare itself.

The Part B annual deductible for 2024 is $240. This means you pay the first $240 of your Part B-covered services each calendar year before Part B begins to pay its share. After you meet the deductible, you typically pay 20 percent coinsurance for most services. Medicare pays the other 80 percent, assuming you are using a participating provider who accepts Medicare.

Understanding the difference between participating and non-participating providers is important for knowing your costs. A participating provider has agreed to accept Medicare's approved amount as payment for services. A non-participating provider has not made this agreement. If you use a non-participating provider