back to Medicare: An Overview
Medicare Part A covers:
- Most inpatient hospital care
- Certain care in a skilled nursing facility (SNF)
- Certain home health services
- Certain hospice care
You will not pay a Part A monthly premium if you are eligible for Social Security retirement benefits (meaning you have 40 or more quarters of Social Security credits — approximately 10 years of full-time work, 4 quarters per year) or Railroad Retirement benefits. If you have 30-39 quarters of Social Security credits, you may buy Part A coverage and pay a monthly premium of $224 in 2015. If you have 0-29 quarters of Social Security credits, you may buy Part A coverage and pay a monthly premium of $407 in 2015.
Topics on this page:
1. Inpatient Hospital Care
- Up to 90 days of inpatient hospital services in each benefit period
- An additional 60 lifetime reserve days
A benefit period begins when you are admitted to the hospital and ends when you have been out of the hospital for 60 days, or have not received Medicare-covered care in a skilled nursing facility (SNF) or hospital for 60 consecutive days from your day of discharge.
Medicare provides 60 lifetime reserve days of inpatient hospital coverage following a 90-day stay in the hospital. These lifetime reserve days can only be used once — if you use them, Medicare will not renew them. Very few people remain in a hospital for 150 consecutive days. In the rare event this does occur, most Medigap policies contain a benefit for an additional 365 hospital days during your lifetime. Medigap policies are designed to pay the copayments below; certain policies also pay the deductible.
As of 2015, Medicare requires the following out-of-pocket inpatient hospital costs:
- Deductible of $1,260 for the first day you are a hospital inpatient. This single deductible covers the next 59 days in the hospital for the same benefit period.
- Copayment of $315 per day for days 61-90 (after you have been in the hospital for 60 days)
- Copayment of $630 per day for days 91-150 (after you have been in the hospital for 90 days; these are your 60 lifetime reserve days)
2. Skilled Nursing Facility (SNF) Care
Medicare covers up to 100 days of care in a skilled nursing facility (SNF) for each benefit period if all of Medicare's requirements are met, including your need of daily skilled nursing care with 3 days of prior hospitalization.
Medicare pays 100% of the first 20 days of a covered SNF stay. A copayment of $157.50 per day (in 2015 ) is required for days 21-100 if Medicare approves your stay.
3. Home Health Services
Medicare covers up to 100 home health visits per period of illness following a hospital stay. Additional home health benefits are available under Part B. Home health visits under both Parts A and B must meet the following conditions:
- A physician has certified you as homebound
- Intermittent skilled nursing or therapy services are required
- Services are provided by a Medicare-certified home health agency
4. Hospice Care
Hospice care is available for terminally ill patients. The goal of hospice care is to keep the patient as comfortable as possible. It does not provide treatment for the terminal illness. Learn more about hospice care (Medicare publication).
5. 2015 Part A Premiums, Deductibles & Coinsurance