The Medigap Market
Medicare Part A: Inpatient Coverage
Medicare Part A covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care.
What's not covered:
Private room (unless medically necessary)
Television and phone in your room (if there's a separate charge for these items)
Personal care items
All people with Medicare are covered when all of these are true:
A doctor makes an official order that says you need to treat your illness or injury.
You need the kind of care that can be given only in a hospital.
The hospital accepts Medicare.
The Utilization Review Committee of the hospital approves your stay.
Your costs in Original Medicare:
Days 1-60: $1,184 deductible for each benefit period in 2013.
Days 61-90: $296 coinsurance per day of each benefit period in 2013.
Days 91 and beyond: $592 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) in 2013.
Beyond lifetime reserve days: all costs.
Medicare Part A: Skilled Nursing Care
Semi-private room (a room you share with other patients)
Skilled nursing care
Physical and occupational therapy*
Speech-language pathology services*
Medical social services
Medical supplies and equipment used in the facility
Ambulance transportation (when other transportation endangers health) to the nearest supplier of needed services that aren’t available at the SNF
Your costs in Original Medicare: Skilled Nursing
Days 1-20: $0 for each benefit period
Days 21-100: $148 coinsurance per day of each benefit period
Days 101 and beyond: all costs
Author: Jesse Bannister
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