Part A and Part B Coverage
Medicare Part A (Hospital Insurance)
Covers inpatient hospital care when:
- You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
- The hospital accepts Medicare.
- In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital.
- $1,600 deductible for each benefit period
- Days 1-60: $0 coinsurance for each benefit period
- Days 61-90: $400 coinsurance per day of each benefit period
- Days 91 and beyond: $800 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime)
- Beyond lifetime reserve days ALL COST
Medicare-covered hospital services include:
- Semi-private rooms
- General nursing
- Drugs as part of your inpatient treatment (including methadone to treat an opioid use disorder)
- Other hospital services and supplies as part of your inpatient treatment
Skilled Nursing Facility (SNF) Care
Medicare Part A (Hospital Insurance)
Covers skilled nursing care in certain conditions for a limited time (on a short-term basis) if all of these conditions are met:
- You have Part A and have days left in your benefit period to use.
- You have a qualifying hospital stay.
- Your doctor has decided that you need daily skilled care. It must be given by, or under the supervision of, skilled nursing or therapy staff.
- You get these skilled services in a SNF that’s certified by Medicare.
- You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, even if it wasn’t the reason you were admitted to the hospital.
- A condition that started while you were getting care in the SNF for a hospital-related medical condition (for example, if you develop an infection that requires IV antibiotics while you’re getting SNF care).
- Days 1–20: $0 for each benefit period
- Days 21–100: $194.20 coinsurance per day of each benefit period
- Days 101 and beyond: All costs.
To qualify for hospice care, a hospice doctor and your doctor (if you have one) must certify that you’re terminally ill, meaning you have a life expectancy of 6 months or less. When you agree to hospice care, you’re agreeing to comfort care (palliative care) instead of care to cure your illness. You also must sign a statement choosing hospice care instead of other benefits Medicare covers to treat your terminal illness and related conditions. Coverage includes:
- All items and services needed for pain relief and symptom management
- Medical, nursing, and social services
- Drugs for pain management
- Durable medical equipment for pain relief and symptom management
- Aide and homemaker services
- Other covered services you need to manage your pain and other symptoms, as well as spiritual and grief counseling for you and your family.
Medicare-certified hospice care is usually given in your home or other facility where you live, like a nursing home.
Medicare Part B Services
Medically Necessary Services
Services or supplies that are needed to diagnose or treat your medical condition from your primary care doctor or specialist (including most doctors services while you’re a hospital patient. This includes diagnostic testing such as MRIs, EKG, CT Scans , outpatient therapy and durable medical equipment.
Health care to prevent illness (like the flu) or other illness detected at an early stage. Includes annual wellness checkups, mammograms, colonoscopies and many other procedures.
Your Out of Pocket
Part B Deductible & Coinsurance
In 2023, you pay $226 for your Part B deductible.
After you meet your deductible for the year, you typically pay 20% of the Medicare- Approved Amount.
Original Medicare does not include part D drugs and you will need to purchase a separate drug plan (RX Plan).
There are two ways to offset your out of pocket cost- Medicare Supplements or Medicare Advantage Plans.