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Does Medicare Cover Hospital Stays?

by David Bynon, last updated

There is no way to sugarcoat it. A hospital inpatient stay can be very expensive. When enrolling in Medicare for the first time or switching coverage, one of the first questions you might have is “will Medicare cover my hospital stay?”

Yes! Medicare provides coverage for the majority of hospital inpatient services. However, they will not cover you indefinitely. Keep reading for a complete understanding of Medicare’s coverage of hospitalization.

Key Takeaways

  • Medicare Part A covers most health care services while you are hospitalized.
  • Medicare will not cover any inpatient care services that are not part of your medically necessary treatment, such as luxury items.
  • Medicare coverage begins once you have paid the deductible for your benefit period during your hospital stay.
  • Once you have been discharged from the hospital and have not returned for a 60-day period, your benefit period ends.
  • Outpatient hospital services, which do not require a hospital stay, are covered by Medicare Part B.
  • Medigap plans help with out-of-pocket costs for hospital services covered by Medicare, as well as allow you to use extra lifetime reserve days.
  • Medicare Advantage plans will cover the same hospital services as Medicare Part A and Part B, but the out-of-pocket costs can vary wildly.

How Does Medicare Cover a Hospital Stay?

Medicare Part A covers doctor-ordered inpatient services during a hospital stay. This includes a wide range of medically necessary services to help with your treatment, including:1Medicare.gov, “Inpatient Hospital Care”, Accessed December 29, 2021

  • Semi-private room
  • Meals
  • Nursing services
  • Medication
  • Diagnostic services
  • Therapeutic services
  • Medically necessary surgeries
  • Medical supplies (IV poles, bandages, etc.)
  • Durable medical equipment (crutches, wheelchairs, etc.)

What Hospital Services are Not Covered By Medicare?

There are certain hospital services and supplies that are not covered by Medicare. This is because it is not medically necessary for you to have these services to get better:1Medicare.gov, “Inpatient Hospital Care”, Accessed December 29, 2021

  • Private nurses
  • Private rooms (unless it is necessary for treatment)
  • Televisions and phones
  • Personal care items (razors, slipper socks, etc.)

How Long Will Medicare Cover My Hospital Stay?

Your Medicare Part A benefit period begins once you are admitted to the hospital by your doctor. Your Part A deductible, currently $1,632, must be paid every new benefit period before Medicare provides coverage for services. Once you have paid your deductible, you pay:1Medicare.gov, “Inpatient Hospital Care”, Accessed December 29, 2021

  • Days 1–60: $0 coinsurance for each benefit period.
  • Days 61–90: $408 coinsurance per day of each benefit period.
  • Days 91 and beyond: $816 coinsurance per each “lifetime reserve day” after day 90 for each benefit period (up to 60 days over your lifetime).
  • Beyond lifetime reserve days: All costs.

Once you are discharged from the hospital and if you do not return for at least 60 consecutive days, that benefit period ends. If you return to the hospital within 60 days after being discharged, your current benefit period will continue.2Medicare.gov, “Glossary: B”, Accessed December 29, 2021

How Does Medicare Cover Outpatient Hospital Services?

Hospitals do not only provide inpatient services. Hospitals also have outpatient departments that handle services for patients that have not been admitted as an inpatient. Examples of hospital outpatient services include:3Medicare.gov, “Outpatient Hospital Services”, Accessed December 29, 2021

Medicare Part A does not cover hospital outpatient services, including emergency room services. Instead, Medicare Part B provides coverage for these services.3Medicare.gov, “Outpatient Hospital Services”, Accessed December 29, 2021 If you are admitted to the hospital and you require these services for your hospital’s outpatient department, your Part B would cover them once you have paid your Part B annual deductible ($240).

Medigap

Medigap policies, also known as Medicare supplemental insurance, help with out-of-pocket costs after Medicare Part A and/or Part B has provided coverage for the service. However, the type of out-of-pocket cost that a Medigap plan will help with varies between plans and can include:8Medicare.gov, “How to compare Medigap policies”, Accessed December 29, 2021

  • Coinsurance
  • Deductibles
  • Copayments
  • Blood (first 3 pints), if needed for your treatment

In addition to helping with out-of-pocket costs, all current Medigap plans allow their beneficiary an extra 365 lifetime reserve days while they hold the plan. If you decide to leave a Medigap plan, you do not get to keep and use any remaining lifetime reserve days.8Medicare.gov, “How to compare Medigap policies”, Accessed December 29, 2021

Medicare Advantage

Medicare Advantage plans are private insurances that must provide the same service coverage that Original Medicare (Part A and Part B). However, that is where a lot of the similarities end, especially for hospital stays. This is because the out-of-pocket costs for covered services can vary wildly from plan to plan compared to Original Medicare.9Medicare.gov, “How do Medicare Advantage Plans work?”, Accessed December 29, 2021

For example, a study from the Kaiser Family Foundation indicates that 98 percent of Medicare Advantage plan members pay less out-of-pocket for the first three days in the hospital. This figure drops dramatically by the fifth day of hospitalization, with 50 percent of Medicare Advantage plan members paying more out-of-pocket than Original Medicare beneficiaries. By the seventh day, about 64 percent of Medicare Advantage plan members pay more out-of-pocket. By day ten, it is 72 percent of Medicare Advantage plan members.10KFF.org, “A Dozen Facts About Medicare Advantage in 2020”, Accessed December 29, 2021

While this study does not include MA Special Needs Plans, it also does not factor in Medigap plans. Medigap plans can help with remaining out-of-pocket costs for Original Medicare beneficiaries, but they are completely unavailable for any MA plan members11Medicare.gov, “Medigap & Medicare Advantage Plans”, Accessed December 29, 2021. This can give Original Medicare beneficiaries an advantage over Medicare Advantage plan members when it comes to the bill after a hospital stay.

Summary

Hospitals are really expensive, but Medicare will help you reduce your remaining costs for most medical services that hospitals provide. The best way to get ahead of your hospital bills is to understand how Medicare Part A and Part B provide coverage for hospital services. You should also consider purchasing a Medigap plan, as it will save you money over time for numerous medical expenses, including hospitalization.

If you are a Medicare Advantage plan member, contact your plan provider and have them explain the potential costs for hospital stays over time. That way, if you have an emergency hospital stay, you will not be surprised by the final bill.

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