Medicaid Part A is hospital and nursing home coverage, not doctor visits

Medicaid Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and home health services. It does not cover outpatient doctor visits, prescription drugs, or routine preventive care — those fall under Medicaid Part B or other parts of the program. Part A is automatic for most people who are on Medicaid; you do not choose it separately the way you might choose Medicare Part A.

The key difference between Medicaid Part A and Medicare Part A is that Medicaid Part A is a state program with rules that vary by state, while Medicare Part A is federal and the same everywhere. If you are on Medicaid, your state decides what Part A covers, how much providers are paid, and whether you pay any out-of-pocket costs. Some states cover more services than others.

Key Takeaways

  • Medicaid Part A covers hospital inpatient stays, skilled nursing facilities, home health care, and hospice services across all states.
  • You do not choose Medicaid Part A separately — it is included automatically when you are on Medicaid, unlike Medicare where you enroll in parts.
  • Your state Medicaid program sets the rules for what is covered, how long you can stay, and whether you owe copayments or coinsurance.
  • Medicaid Part A does not cover outpatient doctor visits, prescription drugs, dental, vision, or hearing aids — those are covered under Part B or other Medicaid categories.

What Medicaid Part A actually covers

Medicaid Part A pays for a hospital bed, meals, nursing care, and basic medical supplies during an inpatient hospital stay. This includes emergency room visits that lead to admission, surgery, and treatment for acute illness or injury. The coverage begins when you are formally admitted to the hospital as an inpatient, not when you arrive at the emergency room.

Skilled nursing facility (SNF) care is covered when you need round-the-clock nursing or physical therapy after a hospital stay. Medicaid Part A typically covers up to 100 days per benefit period, though your state may have different limits. You usually must have been in the hospital for at least three days before Medicaid will cover a nursing home stay.

Home health services covered under Part A include nursing visits, physical therapy, occupational therapy, and speech therapy when ordered by a doctor and delivered in your home. Medicaid Part A also covers hospice care for people with a terminal illness, including pain management, counseling, and comfort care.

What Medicaid Part A does not cover

Medicaid Part A does not pay for outpatient services — that is, care you receive without being admitted to the hospital. Doctor office visits, urgent care, and emergency room visits that do not result in admission are not covered by Part A. Those services fall under Medicaid Part B or other state programs.

Prescription drugs, dental work, vision care, hearing aids, and mental health outpatient services are not covered by Medicaid Part A in any state. Long-term custodial care in a nursing home — care that is not skilled nursing — is also not covered by Part A, though your state Medicaid program may cover it under a different category.

How Medicaid Part A differs by state

Each state runs its own Medicaid program and decides how much to pay hospitals and nursing homes, which services to cover beyond the federal minimum, and whether you pay any costs out of pocket. Some states cover more days in a skilled nursing facility than others. Some states charge small copayments for hospital stays or nursing home care; others do not charge anything.

Your state also decides whether to cover certain optional services like home and community-based care, which lets some people receive care at home instead of in a facility. If you move to a different state, your Medicaid coverage may change, so it is worth checking what your new state covers.

How to find out what your state covers

Contact your state Medicaid office directly — the phone number and website are on your Medicaid card or available through your state health department. You can also call 211 (a free referral line) and ask for your state Medicaid program. Have your Medicaid number ready when you call.

Ask your state program specifically what Part A covers in your state, how many days you can stay in a nursing home, and whether you owe any copayments. If you are admitted to a hospital or nursing home, the facility's billing department can also tell you what Medicaid Part A will cover for your specific stay.

Medicaid Part A versus Medicare Part A

If you are 65 or older and worked long enough to earn Social Security, you are on Medicare Part A, not Medicaid Part A. Medicare Part A is federal and the same in every state. If you are under 65 and on Medicaid, you have Medicaid Part A, which is state-run and varies.

Some people are on both Medicare and Medicaid at the same time — these people are called "dual may be able to access." If you are dual may be able to access, Medicare Part A is your primary coverage for hospital and nursing home care, and Medicaid covers costs that Medicare does not pay. Your state Medicaid program will tell you how this works in your state.

Frequently Asked Questions

Do I have to pay anything out of pocket for Medicaid Part A?

Most states do not charge copayments for Medicaid Part A hospital or nursing home stays, but some do charge small amounts — usually a few dollars per day. Your state Medicaid program can tell you whether you owe any costs. If you cannot afford the copayment, tell the hospital or nursing home billing department; many states waive copayments for people with very low income.

How long can Medicaid Part A cover a nursing home stay?

Federal rules allow up to 100 days per benefit period, but your state may cover fewer days or have different rules. You must also have been in a hospital for at least three days before Medicaid will cover nursing home care. Ask your state Medicaid program or the nursing home what the limit is for your situation.

Does Medicaid Part A cover mental health treatment?

Medicaid Part A covers inpatient psychiatric hospital stays. Outpatient mental health visits, therapy, and counseling are covered under different parts of Medicaid or through your state's mental health program. Ask your state Medicaid office which part covers outpatient mental health in your state.

What happens if I need care but Medicaid Part A does not cover it?

Your state Medicaid program may cover it under a different category — for example, outpatient doctor visits are covered under Part B, and some states cover dental or vision care separately. Contact your state Medicaid office to ask what other coverage is available for the service you need.