Original Medicare is made up of different parts that address coverage. Part A is hospital insurance, and Part B is medical insurance. In addition to inpatient hospital care, Part A helps defray your costs as an inpatient in a skilled nursing facility (SNF) for short-term stays. Part A benefits also include hospice care and some home healthcare services. Medicare benefits are limited to physician-ordered, medically necessary services and supplies.
Inpatient hospital benefits include services and supplies directly tied to your treatment, including a semi-private room, daily meals, general nursing and medication. Skilled Nursing Facility (SNF) coverage includes skilled care and physical therapy. Original Medicare Part A does not cover 100% of inpatient bills.
Your cost-sharing responsibility varies with the facility type, length of stay and scope of services. You are fully responsible for the cost of services outside the Medicare program, such as a private room, private-duty nursing, or other additional items.
Your inpatient cost
The Part A deductible for inpatient hospital care applies to each benefit period, and the number of benefit periods in a year is unlimited. A benefit period starts the day of your hospital or SNF admittance and ends after 60 consecutive days without inpatient care. When you return to a facility after the 60-day time frame, a new benefit period begins.
No copayments are due if you are a hospital inpatient for less than 60 days. You are responsible for a daily copayment from days 61 to 90 and all costs after day 90. Medicare allows you to extend your benefit for up to 60 additional days in a lifetime, known as lifetime reserve days. Part B covers physician in-hospital services, and you are responsible for Part B coinsurance.
Your doctor may determine that you need daily skilled nursing services after the hospital discharges you. Care may include intravenous fluids or physical therapy. If your hospital stay was at least three days and the need for skilled care is related to the reason for hospitalization, then you are eligible for the SNF inpatient benefit. You pay nothing for the first 20 days up to 100 days in each benefit period. Coinsurance applies from day 21 to 100.
During the last quarter of each year, Medicare announces deductible and copayment amounts to take effect on January 1 of the following year.
How other Medicare plans can lower your hospital costs
If you have Original Medicare and choose to buy a Medicare Supplement plan (Medigap), you can lower your cost-sharing responsibility. All 10 Medigap policies cover 100% of the Part A coinsurance and medically necessary hospital costs for up to 365 days after you exhaust your hospitalization benefits. Some supplemental plans cover all or part of the Part A deductible, hospice care coinsurance or copayments, and SNF coinsurance.
An alternative to Original Medicare, you may enroll in a Medicare Advantage plan. Cost-sharing under Medicare Advantage (MA) plans vary. If you enrolled in a Medicare Advantage plan, check your Evidence of Coverage (EOC) for your plan’s deductible, coinsurance and copayments. Some MA plans don’t require a three-day minimum hospital stay before transferring to an inpatient SNF.
A licensed insurance agent can guide you through the search for a Medicare plan that balances the cost and benefits you need.