Medicare covers hospital stays, but there are limitations on the number of days and you may have to pay coinsurance.
Updated Sep 6, 2023 · 2 min read Written by Roberta Pescow Roberta Pescow
Roberta Pescow is a freelance writer specializing in health, home improvement, food, personal finance and lifestyle. Her articles have been syndicated on over 200 websites nationwide.
Reviewed by Debra Nuckols Debra Nuckols
Medicare
Debra Nuckols, a Health Plan Services Consultant at BluePeak Advisors, a Gallagher Benefit Services Inc. division, has been in the managed care industry for 20 years. She specializes in Medicare compliance, corporate compliance, auditing and monitoring, and new-to-Medicare health plan startups. Before becoming a consultant, Debra worked for several national managed care organizations as a Medicare compliance officer, serving as an expert on the matter. In addition to her extensive health plan experience, Debra worked at the Centers for Medicare & Medicaid Services, or CMS, in the Seattle area, where she oversaw national and local Medicare Advantage plans.
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Medicare Part A covers hospitalizations, but you’re responsible for the Part A deductible. After 60 days you’ll have to pay coinsurance, and the amount increases based on the length of your stay.
With the cost of a three-day hospital stay averaging around $30,000, making sure you’re covered for hospital visits is essential [0]
HealthCare.gov . Protection from high medical costs. Accessed Sep 6, 2023.. As long as your hospital accepts Medicare and you have an official doctor’s order that states inpatient hospital care is necessary for your treatment, Medicare Part A will cover your hospital stay. Medicare Part A will sometimes cover hospitalization if you don’t meet these conditions provided the hospital’s utilization review committee approves your stay during your admission.
This coverage includes inpatient care at the following types of facilities, according to Medicare.gov [0]
Centers for Medicare & Medicaid Services . Inpatient hospital care. Accessed Sep 6, 2023. Acute care hospitals. Critical access hospitals. Long-term care hospitals. Inpatient psychiatric facilities (with a 190-day lifetime limit). Inpatient rehabilitation facilities.The following services are included in your Medicare Part A hospital coverage:
A semi-private room. Medications, including methadone. Nursing care. Other hospital supplies and services needed for your treatment.Hospital inpatient care is also covered if you participate in a qualifying clinical research study.
Be aware that Medicare Part A covers only Medicare-approved hospital services and items, not the doctors' services you receive while hospitalized, which fall under the umbrella of Medicare Part B . Your Part B coverage pays 80% of any Medicare-approved doctors' services you receive while hospitalized.
Medicare Part A has a deductible of $1,632 in 2024 for each benefit period. Once your deductible is met, here’s how coverage and coinsurance works:
Days 1-60 of hospitalization: You owe $0 coinsurance. Days 61-90 of hospitalization: You owe $408 per day in 2024 for each benefit period.Days 91 and after: You owe $816 in 2024 for each of your “lifetime reserve days” after day 90 for each benefit period, of which you have 60 to use over the course of your lifetime.
Days after lifetime reserve is used up: No coverage. You owe full cost.A benefit period starts the day you’re admitted for an inpatient hospital stay or skilled nursing facility care. It ends when you haven’t received inpatient hospital or skilled nursing care for 60 days in a row. If you’re admitted after that, you’ve started a new benefit period and must pay the deductible again.
There are some exclusions to be aware of that Medicare Part A doesn’t cover, including:
Private rooms (unless they’re medically necessary ). In-room TV or phone (if the hospital charges separately for these services). Private-duty nurses. Personal care items, such as socks or razors.Medicare Supplement Insurance, or Medigap , can help reduce the hospital expenses that Medicare Part A (hospital insurance) and Part B (medical insurance) don’t cover. Depending on the Medigap plan type , you can purchase a policy that covers the Part A deductible, Part A coinsurance and hospital costs, and the first three pints of blood for a transfusion.
Medigap plans are standardized, so you get the same Medicare benefits from any company offering the specific plan type. However, the premiums and available plan types can vary depending on your location, so it’s important to shop around to find the most affordable plan that best suits your health needs.
Medicare Advantage plans are required to provide the same level of coverage as Original Medicare. So any Medicare Advantage plan you choose will cover the same services — and some plans may offer additional benefits such as full hospital coverage beyond 90 days. However, some Medicare Advantage plans have a daily copay that kicks in right away for your first few days or full week in the hospital — and these daily costs could add up to significantly more than the Part A deductible, depending on your specific plan and the length of your stay. (There’s no cost for the first 60 days of basic hospitalization with Medicare Part A, other than the Part A deductible.)
Because Medicare Advantage is offered through private health insurance companies, the terms, copays, coinsurance and benefit details will vary from plan to plan — and benefits are substantially reduced if your hospital or medical provider is out-of-network, unless you require urgent or emergent care.
When comparing Original Medicare and Medicare Advantage hospital coverage, consider the total potential out-of-pocket expenses for extended hospital stays. Original Medicare doesn’t limit your total hospitalization costs (unless you have a Medigap plan, which covers certain out-of-pocket expenses), but Medicare Advantage plans cap annual out-of-pocket expenses once you’ve hit a spending threshold. It can be as high as $8,850 out of pocket in 2024 . Then they’ll pay 100% of covered services for the remainder of that year (as long as you’ve used in-network providers and hospitals).
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
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Roberta Pescow is a freelance writer specializing in health, home improvement, food, personal finance and lifestyle. Her articles have been syndicated on over 200 websites nationwide. See full bio.
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