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Federal Health Insurance Guide: Which Part of Medicare Covers Inpatient Hospital Charges?

Federal Health Insurance Guide Which part of Medicare covers inpatient hospital charges

Hospital stays are expensive. Without medical insurance, it can cost you thousands of dollars. While for some, it may not be the biggest concern, those living hand-to-mouth will be heavily affected by this.

For such people, the Federal government offers the Medicare program. It is a health insurance plan designed for people 65 or older as well as disabled youngsters. Fortunately, Medicare pays for inpatient hospital expenses to a great extent. Now you must be wondering which part of Medicare covers inpatient hospital charges.

Medicare part A covers most part of the inpatient hospital charges. If you are eligible for Medicare, you can get financial assistance from its part A coverage plan. However, there is a condition, in order to get the full scope of benefits, Medicare requires you to pay some portion of the bill.

For more detailed information, pertaining to Medicare Part A, inpatient hospital costs, etc. keep on reading.

Part of Medicare covers inpatient hospital charges

Medicare part A covers skilled nursing facilities and inpatient hospital charges along with some home and hospice care. To be precise, Medicare part A pays for diagnostics, inpatient surgeries, and blood work apart from hospital stays.

Part of Medicare covers inpatient hospital charges

source:clinicaladvisor.com

Here is a breakdown of the medical treatments that part A covers:

  • Blood transfusions during a hospital stay
  • Limited home care
  • Limited skilled nursing facility
  • Hospice care

If the patient has been admitted to a facility, the Part A plan will cover the following things:

  • The hospital room
  • Meals
  • Nursing facilities
  • Medications
  • Medical supplies
  • Medical equipment like crutches wheelchairs and walkers
  • Rehabilitation services
  • Diagnostics

It’s somewhat similar to what you pay for in insurance plans. In fact, in some insurance plans, you even pay for deductibles, premiums, and other costs as well.

In 2022, Medicare part A deductible is $1,556 per benefit period.

How does Medicare Part A deductible apply?

Unlike other deductibles, Part A deductible is applied to each benefit period. For instance, it starts with the time you are admitted to a hospital till 60 consecutive days from the day you have been admitted.

That means, if you are out of the hospital and come back home within the 60-day window, you won’t be charged for another deductible.

Similarly, if your stay goes longer than 60 days period as suggested by the guidelines, you will have to pay for another deductible.

How does Medicare Part A deductible apply

source:ncoa.org

How does coinsurance work for Part A?

Once the patient pays their part, Medicare will cover the remaining inpatient hospital care for up to 60 days in the facility.

If your hospital stay goes longer than 60 days, you can extend your current benefit period by paying daily coinsurance. It starts from day 61 and goes up to day 90 if consecutively counted.

According to the 2022 updated policy, beneficiaries must pay $389 per day in daily coinsurance from day 61.

If you have consumed 90 days of inpatient hospital charges but have not been discharged yet, Medicare offers an additional 60 days of coverage from your lifetime reserve days. However, for that also, you will need to pay a daily coinsurance.  Lifetime reserve days are non-renewable. That means, even if you become qualified for another benefit period, these days won’t be renewed.

Note that, Medicare won’t pay for your inpatient-related hospital charges like room and board if you run out of the benefit days during the benefit period. In order to get qualified for a new period or get extra days of coverage, you will be required to remain out of the hospital or facility for 60 consecutive days. After that, you will be eligible for a new Part A deductible.

2022 Breakdown of Part A deductible and coinsurance

Medicare deductible and coinsurance fee

Medicare inpatient hospital charges (initial 60 days)

$1,556

Daily coinsurance (Day 61 – 90)

$389/day

Daily coinsurance for lifetime reserve days (Additional 60 days)

$778

Each day after finishing lifetime reserve days

Full cost

Eligible healthcare centers for Part A

While Medicare Part A coverage covers inpatient hospital charges for many facilities, coverage may vary from facility to facility.

Below are some Medicare-approved healthcare facilities:

  • General Acute Care Hospitals: These facilities provide instant care for acute illness and injuries and come under Medicare’s approved hospitals. For instance, physicians and surgeons at General acute care hospitals treat urgent conditions like brain hemorrhage or heart stroke.
  • Inpatient Psychiatric Facilities: Medicare offers a similar inpatient fee coverage structure for both General and Physiatrist facilities, except for one thing, it offers 190 days of inpatient physiatrist hospital care in a lifetime.
  • Rehabilitation Centers: Rehabilitation centers provide care after an illness, injury or a medical condition. Their services generally include occupation, physical and speech therapy.

Fortunately, rehabilitation centers are eligible for part A Medicare plan and offer inpatient care if the doctors find it medically necessary for the patient’s health.

Out-of-pocket expenses for rehabilitation centers would be the same as those of other hospitals.

  • Long-Term Acute Facilities: Some medically complex conditions that may not be treated in general hospitals are administered in long-term acute facilities with extended stays of up to several weeks. Sometimes when a patient’s condition is stabilized in general hospitals, they are transferred to long-term acute facilities to provide specialized treatment for an extended period of time. However, Medicare covers inpatient hospital plans the same for both.
  • Skilled Nursing Facilities: Skilled nursing services include 24-hour nursing care, help with daily chores like bathing and dressing, and physical therapy.

Patients who suffer temporary injuries require these services for a short period of time. However, those with lifetime or long-term disabilities or illnesses may require it for longer. Medicare Part A covers nursing facilities for a restricted period if the below conditions are met:

  • You have Part A coverage and have days left in your benefit period
  • You are eligible for the inpatient hospital stay
  • Doctors have prescribed you the necessary daily skilled care

Medicare coverage for skilled nursing care facilities:

Day 1 – 20

$0 after the initial deductible

Day 21 – 100

$194.2/day coinsurance

Day 101 – Beyond

Full cost

Unfortunately, Medicare part A does not pay for long-term inpatient nursing facilities. That said, if a patient has been shifted back to a general or acute care facility, Medicare coverage will be resumed.

Other Options for inpatient hospital coverage

If you want to further explore your options for inpatient hospital coverage, check Medicare Advantage Part C plan offered through private insurers. Not just it includes all the benefits from the original Medicare plan (A, B, and C) but it provides coverage for additional benefits.

You may get additional coverage for the following services through Medicare Advantage Plan.

  • Dental
  • Vision
  • Hearing
  • Fitness memberships

Wrap Up

Hopefully, you are clear on which part of Medicare covers inpatient hospital charges. Remember that part A will cover all your major hospital expenses for a limited period. Suppose you or any of your family members are expected to stay in a hospital for more than the benefit period. In that case, you might need to check your insurance coverage to analyze your out-of-pocket expense. Lastly, Medicare part A will cover inpatient expenses to an extent. You are responsible for some portion of the total bill.