Hospital care may be a need for many of us eventually in our lives. Please note the benefits you may get under Original Medicare (Part A and Part B). As well as the benefits you may get for the type of Medicare hospital coverage that you have.
Hospitals employ surgeons, nurses, and physicians who provide inpatient and outpatient services. Below is a list of facilities that include hospital care treatment, these include:
- Psychiatric hospital
- Long-term care hospital
- Qualifying research study
- Critical access hospital
- Inpatient rehabilitation facility
- Acute care hospital
If you are in the hospital and need inpatient care, then the extent of how long you may be in the hospital varies. The essential care you need and the severity of your condition determines how long you stay in the hospital. The hospital may transfer you to a long-term care hospital if you need an extended hospital stay. Long-term care hospitals are facilities that concentrate on handling patients who need more time to heal. Typically patients in long-term care come from the intensive-care unit of a general hospital. If you have a serious condition, long term care hospitals may treat you. They also may offer pain management, specialized rehabilitative, and trauma services.
Are you eligible for hospital coverage?
If you meet all the prerequisites below then Medicare will pay for your inpatient hospital stay:
- The hospital’s Utilization Review Committee approves your hospital stay.
- The hospital you go to accepts Medicare and participates in the Medicare program.
- You are a Medicare Part A enrollee.
- You require a hospital stay for the care you need
- The hospital formally accepts you to stay and your doctor orders 2 or more midnights of essential inpatient hospital care.
What are the Medicare benefits for hospital stays?
Medicare Part A or Part B may pay for your hospital services depending on your hospital status. Medicare may pay for your skilled nursing facility care (SNF) following your hospital stay. This also depends on your hospital status. And Medicare will only pay for SNF care if you have a qualifying 3-day inpatient hospital stay.
Medicare Part A will cover you if you’re accepted to the hospital as an inpatient. Medicare Part B will cover you if you’re getting observation services, outpatient surgery, or other services in a hospital. Please note that the hospital has to formally accept you as an inpatient to have inpatient status. An overnight hospital stay does not make you an inpatient.
The following is the Medicare hospital coverage that you will get under Medicare Part A as an inpatient. The services include but are not limited to:
- Drugs given as part of your treatment
- Meals
- Nursing care
- A semi-private (shared) room
The following is the Medicare coverage that you will get under Medicare Part B as an outpatient, even if you get them in a hospital. Medicare Part B may pay for supplies and services like:
- X-rays and other scans
- Lab tests
- Preventive services
- Doctor visits
- Second opinions on surgeries
- Durable medical equipment
- Ambulance transportation
Hospital services not covered by Medicare
Below is a list of hospital services that Original Medicare does not cover:
- A phone or television
- A private room (unless it is medically needed)
- Personal items like toothpaste
- Private-duty nursing
Medications
Medicare Part A will typically pay for drugs handed to you during your inpatient hospital stay. Drugs administered in a doctor’s office or a hospital outpatient setting will have limited Medicare Part B coverage.
If your status in the hospital is an outpatient, prescription drugs you can take by yourself will usually not be paid for by Medicare. If you want these medications covered, you may be able to through a Medicare Advantage Prescription Drug plan or stand-alone Medicare Prescription Drug plan (Part D). If you want more information, contact your Medicare plan.
Costs and benefits for hospital services
Year after year, your expenses for hospital care like copayments, coinsurance, and/or deductibles may change. If you want the most present cost information, go to Medicare.gov.
Your expenses for an inpatient hospital stay under Medicare Part A include:
- A coinsurance cost for each lifetime reserve day.
- All expenses for every day after you used up all your lifetime reserve days.
- If you need an inpatient psychiatric hospital stay, then 190 days of inpatient psychiatric hospital care in your lifetime are under Medicare Part A coverage.
- A one-time hospital deductible for days 1–60 in each benefit period. No coinsurance included.
- A coinsurance cost every day for days 61–90 in each benefit period.
Under Medicare Part B:
- You will owe a copayment for every individual outpatient hospital service.
- The copayment can be separate for every service, but never more than the Part A hospital deductible.
- In a few situations, your cumulative copayments for all covered hospital outpatient department services can be more than the inpatient hospital deductible.
- Usually, you will owe 20% of the amount approved by Medicare for most doctor services you get when you’re a hospital outpatient or inpatient.
Medicare Advantage plans may have different expenses than Original Medicare. However, Medicare Advantage must have at least the same level of benefits as Original Medicare. If you want more information about the expenses for hospital care, go over your individual plan.