Medicare’s coverage can often seem intricate and confusing, especially when it comes to understanding which specific parts of the program cover services like room and board during hospital stays. This article breaks down which parts of Medicare provide coverage for room and board at the hospital, explores what specific services are included, and provides information on how to find room and board coverage outside of the commonly known Part A.

Medicare Part A: The Primary Source for Room and Board Coverage

Medicare Part A, also known as hospital insurance, is the primary part of Medicare that covers room and board at the hospital. This coverage is crucial for beneficiaries during inpatient hospital stays, skilled nursing facility care, and in some cases, hospice care.

What’s Covered Under Part A?

• Hospital Stays: Medicare Part A covers semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, along with other hospital services and supplies. This coverage is essential during acute care periods where an inpatient stay is necessary for the treatment of a disease or injury.
• Skilled Nursing Facility (SNF) Care: If you require skilled nursing care as part of your recovery, Medicare Part A covers room and board in a skilled nursing facility following a qualifying hospital stay (at least three days). The coverage typically includes meals, nursing care, and rehabilitative services, provided the services are aimed at improving your condition or maintaining your current condition following hospital discharge.

Limitations and Costs:

While Medicare Part A covers room and board during hospital stays, it’s important to note that it comes with specific limitations. Coverage is typically provided for up to 90 days per benefit period for hospital stays, with a daily coinsurance applied after the first 60 days. For skilled nursing facility stays, coverage is provided for up to 100 days per illness, with coinsurance kicking in after the first 20 days. There is also a deductible that applies per each benefit period Part A services are used.

Beyond Part A: Other Medicare Coverage Options

While Medicare Part A is the primary source for room and board coverage during hospital and skilled nursing facility stays, it’s crucial to consider where else you might find coverage, especially if Part A coverage limits are exceeded or specific conditions are not met.

Medicare Part C (Medicare Advantage)

• Enhanced Coverage: Medicare Advantage plans, offered by private insurance companies, must cover everything that Original Medicare (Part A and B) covers but often come with additional benefits. Some Medicare Advantage plans might offer extended coverage for hospital stays or SNF care beyond the limits set by Original Medicare.

Medigap (Medicare Supplement Insurance)

• Cost Coverage: If you are concerned about the out-of-pocket costs associated with extended hospital stays or SNF care (like coinsurance, copayments and deductibles), a Medigap policy might help to fill these gaps. These policies can reduce your share of the costs and provide a cushion against financial strain during longer-than-expected hospital stays.

Medicare Part A is your go-to source for coverage of room and board during hospital stays and skilled nursing facility care under Medicare. However, exploring Medicare Advantage and Medigap plans can provide additional protections and extend your coverage. It’s important to carefully review the terms of any Medicare Advantage or Medigap plan before enrolling to understand exactly what is covered and any additional benefits that may be pertinent to your needs.

For more detailed information about what Medicare covers, you can consult with a licensed Medicare advisor here at AMAC who can provide insights tailored to your specific health care needs and financial situation.

For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote below!