Demystifying Medicare Part A: 10 Things It Covers, 9 Things It Doesn’t

Health care is likely to be one of the most important parts of your financial planning for retirement. Three months before your 65th birthday, you can enroll in Medicare. If you choose to retire early, you'll need to set aside more money for health insurance until you reach the magic age.

So, what will you get when you go on Medicare? Original Medicare has two parts. Part A covers in-hospital medical care you receive, while Part B covers preventive care, such as trips to the doctor’s office.

Take a closer look at just Medicare Part A, including what it covers but also what it doesn't, allowing you to know what to focus on as you plan your retirement.

You’ve been admitted to the hospital for any type of care, including emergency procedures, planned procedures, or testing. A doctor orders this admission for some reason, often due to an injury or illness.

It's important to avoid foolish mistakes during your stay. Medicare will cover the cost of general nursing and the hospital services and supplies that you receive.

Medicare coverage will include medications you receive in the hospital, such as medications through an IV or pills.

This includes any medication a doctor prescribes for you during the hospital stay. It includes methadone as a treatment for addiction use disorders as well.

While you may not enjoy the meals you receive, Medicare Part A covers the cost of them. It also covers your semi-private room. 

If the hospital only has a private room available and isn’t charging you extra for that specific request, Medicare will cover that cost, too.

Your Medicare Part A coverage includes 190 days in a psychiatric hospital when it’s necessary care. A doctor must order you to receive this type of care.

In addition to a hospital, Medicare Part A will cover stays in a range of hospital settings, including acute-care hospitals, critical access, inpatient rehab, inpatient psychiatric facilities, and long-term care facilities.

When you need long-term care in a hospital setting, Medicare will cover some of those costs, but there is a deductible requirement you must meet.

For the first 60 days, that’s $1,632. Then, from Day 61 through Day 90, you have a $408 copayment for each day. After Day 91, the copayment jumps to $816 per each “lifetime reserve day,” and this continues for up to 60 days from that point.

After those lifetime reserve days, no coverage is provided. This includes care for pain management, heat trauma treatment, and respiratory care.

Medicare Part A covers short-term stays in a skilled nursing facility if a doctor decides you need to have that care. 

You must obtain the services at a Medicare-certified location. Medicare also requires that this facility is necessary after a hospital stay.

If you are in a skilled nursing facility for qualified reasons, Medicare Part A will cover your meals, skilled nursing care you need, a semi-private room, medications, and social services.

Any medical supplies and equipment used, along with dietary counseling, will also be covered.

If you need physical therapy, occupational therapy, or speech-related therapy — and it is considered specifically necessary for your medical goals — that’s covered as well.

Many people worry about how much they'll have to pay to get to the hospital if an emergency happens to occur. This can cause a worse emergency because people are reluctant to call.

Thankfully, your coverage will include transportation by ambulance or other medical transportation as needed to the nearest Medicare-approved and available skilled nursing facility.

Are you participating in a clinical research study that requires inpatient care? You can count on Medicare Part A coverage to meet those costs, as listed above, for a qualifying study.

Hiring a private nurse or receiving specialized nursing care that goes above and beyond what general nursing offers (without the need for that level of care) isn’t covered by Medicare Part A.

For example, if you want to bring in a private nurse to care for you during your hospital stay, you’ll have to pay for that out of your pocket.

There are situations when a private room is necessary medically, such as when infection control is critical or when the hospital only offers private rooms for patients receiving specific types of care. Those situations are covered.

You cannot request a private room and have Medicare pay for it. If doctors provide you with one without request, perhaps because that’s all that’s available. In that case, Medicare will cover that cost.

We’re not talking about anything fancy here. However, if the hospital charges for the use of the phone, TV, or other in-room amenities, Medicare will not cover those costs.

You can certainly tap into the free WiFi at the hospital and use your laptop (brought from home) to get something to do while you recover.

If the hospital requires you to wear those non-skid socks with grips on the bottom, Medicare is likely to cover them. 

However, any personal care items you need, such as hygiene supplies, razors, and deodorant, are not covered. Many hospitals provide the basics free of charge to patients, though, which can help you save some spending money.

During the first 20 days in a skilled nursing facility, Medicare Part A will cover your costs.

At Day 21 and through Day 100, you receive only $204 coinsurance per day of your stay, and you become responsible for costs charged above that. After Day 101, all costs become your responsibility.

Though Medicare will cover the costs associated with prescription glasses needs, it does not cover dental care, eye exams, dentures, or hearing aids. 

You have to pay for these services through a supplemental plan or out-of-pocket.

You will have to pay for any type of non-medically required care. That includes cosmetic surgeries, massage therapy, acupuncture, yoga, or other types of highly specialized holistic care.

Medicare isn’t going to pay for these higher-end medical services, such as boutique medicine providers, retainer-based medical providers, or direct care from a specific medical provider.

You must use a Medicare-approved provider for all of the care you receive.

This is a trick answer. If you have Original Medicare, you have two parts, Part A and Part B. Part A does not cover routine medical care, like standard doctor’s appointments or outpatient treatment for an illness. 

However, Part B does cover this. It’s important to know the difference in each of these care plans. Once you understand then it can eliminate some money stress and help you prepare for the future.

Are you unsure if the care you need is covered? Use the Medicare Coverage tool, a simple online tool where you can enter the test, item, or service that you need, and it will tell you if it’s typically covered.

There are ways seniors can save money on the out-of-pocket costs they have, including Medicare Advantage Plans and Medigap care. If you qualify for Medicaid, that may further extend the protection you have.