C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 409—HOSPITAL INSURANCE BENEFITS › Subpart A—Hospital Insurance Benefits: General Provisions

42 C.F.R. § 409.5

General description of benefits

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Hospital insurance (Part A of Medicare) helps pay for inpatient hospital or inpatient CAH services and posthospital SNF care. It also pays for home health services and hospice care. There are limitations on the number of days of care that Medicare can pay for and there are deductible and coinsurance amounts for which the beneficiary is responsible. For each type of service, certain conditions must be met as specified in the pertinent sections of this subpart and in part 418 of this chapter regarding hospice care. Conditions for payment of emergency inpatient services furnished by a nonparticipating U.S. hospital and for services furnished in a foreign country are set forth in subparts G and H of part 424 of this chapter.

[71 FR 48135, Aug. 18, 2006]
Notes of Decisions
Cited in 4 cases (1 in the last 5 years), 1991–2023 · leading case: Good Samaritan Hosp. v. Shalala, 508 U.S. 402 (1993).
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Good Samaritan Hosp. v. Shalala, 508 U.S. 402 (1993). “Part A Medicare benefits, for example, cover, among other things, "inpatient hospital services," see 42 CFR § 409.5 (1992), a term that encompasses everything from bed and board, nursing services, and use of hospital facilities to medical social services, drugs, biologicals,…”
Grossmont Hosp. Corp. v. Sebelius, 903 F. Supp. 2d 39 (D.D.C. 2012). “§§ 1395c, 1395d, 1395x(u); 42 C.F.R. § 409.5 . Hospitals may participate in the Medicare program as providers of services by entering into provider agreements with the Secretary, 42 U.”
Downtown Med. Ctr./Comprehensive Health Care Clinic v. Bowen, 944 F.2d 756 (10th Cir. 1991). “§ 1395ff to provide for judicial review of Part B amount determinations, of a type akin to that already available under Part A. Omnibus Budget Reconciliation Act of 1986, Pub.”
Ascension Providence v. Becerra (N.D. Ind. 2023). “42 C.F.R. § 409.5 . Under the Inpatient Prospective Payment System (IPPS), hospitals providing inpatient Medicare services are paid a fixed amount for each patient discharged, regardless of actual costs incurred.”
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