What Are Medicare Inpatient Services - Are You Covered?

By: Meredith Miller
Published: Friday, October 26 2018
Last Updated: 18 days ago

Determining Inpatient Services Coverage And Eligibility Is An Important Step When Looking Into Hospital Care Options

There are 4 parts of Medicare which include Inpatient Care services, also known as Medicare Part A (of parts B, C, and D) if you are deemed eligible after applying. Medicare Part A is the care and assistance one receives while physically in the hospital that Medicare covers under certain eligibility guidelines, as well as certain deductibles according to the plan under Part A.

Details regarding this A can be seen here via the Medicare link

Will Medicare Cover You?

To ultimately determine coverage, it is always recommended to reach out and contact a customer service representative at 1-800-MEDICARE (1-800-633-4227). Once Medicare confirms you as a beneficiary then you are also eligible under part A Medicare Inpatient plan to receive inpatient care and you will be covered as a hospital inpatient.

Then after it is determined that you are eligible as a beneficiary under Medicare, you are then qualified to receive all 4 Medicare Parts under the overall umbrella within the program itself; to include Part A.

Inpatient Services Covered By Medicare Part A

As an inpatient receiving inpatient care, and have Medicare coverage, you are then considered a Medicare inpatient and are eligible to items such as operating rooms and recovery rooms, semi-private rooms, intensive care, lab tests and x-rays as an inpatient, some blood transfusions, meals, general nursing, drugs for your inpatient care as a Medicare patient, and possibly other supplies and equipment needed via the primary care physician recommendations.

You may be also eligible for non-hospital items under Part A to include Medical Social Services, Occupational and Physical Therapy, Part-time or intermittent nursing home care or even limited home health care. You can also receive coverage for ambulance transports, and speech-language pathology services, depending on the hospital and what its plans cover.

Details can be seen here in the actual policy manual via the link. But it would always be prudent to contact your local physician, caregiver or hospital for that matter to confirm what they do offer within their given network as well.

Inpatient Care Not Covered

Items not covered for within inpatient services that are Medicare inpatients include private-duty nursing, private rooms-unless medically necessary, television and phone while staying in a room, and some personal items such as razors and slipper sox for example.

Coverage for limited home health services is not 24 hours either, nor does it provide homemaker services or meals delivered to a home.

Details can be found here within the link as well in Medicare.gov.

Inpatient Costs

Inpatient services for the Medicare inpatient will have certain costs they would be responsible while Medicare can help assist with the rest. These include $0 costs staying in a facility from 0-20 days. Following this and on the 21st day and up to the 100th day, the cost is roughly $168 per day. On the 101st day, the beneficiary is totally responsible for the ensuing costs.

For hospice care plans, it breaks down as follows: the charge is $5 per prescription and 20% of the durable medical equipment a patient uses at home as well as roughly 5% of the respite care programs that are approved by Medicare itself.

Supplemental Plans For Medicare Inpatient Coverage

There are massive amounts of options for those seeking supplemental coverage for inpatient services under Medicare to choose from. This link provided here is just one of many as an example.

Most supplemental plans will require some basic and personal information to be gathered initially from an applicant when looking into them to see if they are the right fit or not for the beneficiary in general.

Some are not all that familiar processing applications nor navigating through the information altogether. Others are simply not comfortable in regards to submitting private information in this manner altogether. Thus, the best course of action in this case and always strongly recommended, they should contact a professional by either calling Medicare customer service at 1-800-MEDICARE to be directed to a local area to start and to perhaps be connected to the local Medicare Ombudsman to help you navigate through this part of the coverage.

Medicare is in place for those that have worked a very long time to qualify as beneficiaries and inpatient services-Medicare Part A-is truly among the most important features and benefits of the plan overall.

Forethought to hospital care and what it entails is the most optimal course to follow if at all possible and seeking advice and consultation from a local Medicare Ombudsman once again is the most ideal way to go about gathering the needed information and most importantly, to ensure that you are indeed covered.