Medicare does not cover every cost of your hospital bill but Part A and Part B can significantly reduce your cost responsibility.
A Medicare Supplement Insurance (Medigap) plan added to Parts A and B may be able to provide further help.
When you become an inpatient, Part A may also pay for your expenses related to the facility’s emergency department before you were admitted as an inpatient.
Part A of Original Medicare, called “hospital insurance,” covers hospital stays. Part B of Original Medicare, called “medical insurance,” also helps with the cost of hospital stays and covers doctors’ services while you’re in the hospital.
Medicare Advantage (Part C) can replace Original Medicare and must offer at least the same Medicare coverage for hospital stays as Parts A and B. Some Medicare Advantage plans also provide additional coverage for hospital stays.
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Medicare does not cover every penny of your hospital bill but can significantly cut your bottom line. Here are a few costs you can expect:
- Days 1 to 60: After you pay the Part A deductible for an inpatient stay ($1,556 in 2022), you pay nothing for the hospital stay itself for Days 1-60.
- Days 61 to 90: You pay coinsurance ($389 per day in 2022).
- Beyond 90 days: You start using your 60 “lifetime reserve days” with a coinsurance of $778 a day in 2022.
After you have paid your annual Part B deductible ($233), Medicare will pay 80% of your approved doctors’ services while in the hospital (you pay the other 20%). A Medigap supplemental insurance plan added to Parts A and B may be able to provide further help.
Alternatively, a Medicare Advantage plan may help. All Medicare Advantage plans, for example, offer the protection of an annual out-of-pocket maximum. Original Medicare doesn’t have an out-of-pocket maximum, and just two of 10 Medigap plans do.
Now you know how Medicare helps pay for hospital stays, but it’s just as vital that you understand what qualifies as a hospital stay.
In most cases, the “two-midnight rule” applies, meaning that you must be officially admitted to a Medicare-approved facility and then spend at least two midnights there for Part A of Original Medicare to provide coverage.
There are some exceptions, and the rule doesn’t always apply in some Medicare Advantage policies.
In addition to a traditional hospital, you can also have an inpatient hospital stay at other facilities, like an inpatient rehabilitation center, where Medicare Part A offers inpatient physical therapy benefits with coinsurance costs slightly different than traditional hospital stays:
- Days 1-60: $0 after you reach your deductible.
- Days 61-90: $389 daily coinsurance.
- Day 91 and beyond: $778 daily coinsurance for up to 60 lifetime reserve days.
Inpatient hospital care also can be at an acute care hospital, a critical access hospital, an inpatient psychiatric facility, and a long-term care hospital.
When you become an inpatient that qualifies for Part A coverage, Part A may also pay for your expenses related to the facility’s emergency department before you were admitted as an inpatient. Part B may cover related ambulatory services, minus 20% coinsurance.
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For Part A coverage, an inpatient hospital stay is considered a “benefit period.” A benefit period lasts up to 90 days, with the first 60 days requiring you to pay no coinsurance and days 61-90 requiring you to pay $389 of coinsurance per day in 2022. Each benefit period has its own Medicare hospital Part A deductible ($1,556 in 2022), and the benefit period ends once you go 60 days without inpatient hospital care.
If you stay in the hospital more than 90 days within a benefit period, you can use some or all of your 60 lifetime reserve days, which require you to pay $778 in daily coinsurance in 2022. Lifetime reserve days can be utilized over multiple benefit periods.
After you have used your lifetime reserve days, Part A won’t provide you with any other coverage.
A GoHealth licensed insurance agent can help you compare plans to meet your needs. A Medigap policy added to Original Medicare, or switching to a Medicare Advantage plan, may help you with expensive coinsurance.
When medically necessary, Medicare Part B (or your Medicare Advantage plan) will cover the rental or purchase of a hospital bed for use at home, save the standard deductible and 20% coinsurance that is your responsibility. The Medicare-approved bed is covered as durable medical equipment.
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