Inpatient Hospital Coverage
Medicare Part A covers inpatient hospital care, but you still have to pay a deductible — $1,408 in 2020. There is no coinsurance for the first 60 days of your hospital stay, but you will have to pay more for days 61 through 90 and you’ll pay all costs after you run out of “lifetime reserve days.”
What Is Inpatient Hospital Care?
Hospital services include both inpatient and outpatient care. Medicare Part A generally pays for hospital care when you are expected to need to be hospitalized through two or more midnights for medically necessary services that can only be performed in a hospital.
Inpatient hospital care refers to care you receive starting on the day you are formally admitted to the hospital. It ends the day before you are discharged.
- The hospital accepts Medicare.
- You have a written doctor’s order to admit you as an inpatient to treat your illness or injury.
- In some cases, you’ve already been admitted to the hospital and its Utilization Review Committee approves your stay as an inpatient.
However, you may also be in the hospital for outpatient care. This can happen if you are kept in a hospital for emergency or observation services, outpatient surgery, lab tests or X-rays, or other hospital services but your doctor has not written an order to admit you to the hospital.
Medicare Part A may not cover your hospital stay if you’re not considered an inpatient, but Medicare Part B may pay for some or all of your outpatient hospital services.
|Situation||Inpatient or Outpatient||What Part A Pays||What Part B Pays|
|Admitted to the hospital after showing up in the emergency room.||Outpatient until formally admitted with a doctor’s order, then inpatient.||Inpatient care and any outpatient services for three days prior to hospital admission.||Doctor services|
|You visit the ER for chest pains and the hospital keeps you for two nights, one for observation before your doctor writes an order for inpatient admission.||Outpatient until you are formally admitted on the doctor’s order. Inpatient after admission.||Inpatient hospital stay and all related outpatient services in the three days before admission.||Doctor services|
|Outpatient surgery at a hospital, but you are kept overnight for observation without an inpatient order from your doctor.||Outpatient||Nothing covered||Doctor services and outpatient services, including lab tests, surgery and IV medicines.|
|You have a doctor’s order for inpatient care, but the hospital changes your status to outpatient. Your doctor agrees with the change.*||Outpatient||Nothing covered||Doctor services and hospital outpatient services.|
What Inpatient Care Does Medicare Cover?
Medicare covers certain hospital care and medical services if you are a hospital inpatient. This coverage applies to acute care, critical access and long-term care hospitals, inpatient rehab, psychiatric and skilled nursing facilities and inpatient care if you are part of a qualifying clinical research study.
- Semi-private room
- General nursing
- Drugs as part of your inpatient care
- Other hospital services and supplies
- Private-duty nursing
- Private room, unless medically necessary
- Telephone and phone in your room (there is a separate charge)
- Personal care items such as razors, toothbrushes, slipper socks
Costs of Medicare Inpatient Care
Inpatient care usually falls under Medicare Part B, but you may be responsible for some of the costs out of your own pocket.
- $1,408 deductible for each benefit period
- Days 1 to 60 of Hospitalization: $0 coinsurance for each benefit period
- Days 61 to 90: $352 coinsurance per day of each benefit period
- Days 91 and beyond: $704 coinsurance per each lifetime reserve day after day 90 of each benefit period (you only have 60 of these days for your lifetime)
- Beyond Lifetime Reserve Days: All costs
Medicare inpatient coverage of psychiatric hospitalization is limited to 190 days over the course of your lifetime. There are also certain hospital services that are not covered.
What Are Medicare Lifetime Reserve Days?
Lifetime reserve days are extra days that can be added to hospital stays beyond 90 days. But you only get 60 of these extra days over the course of your life. When you use these lifetime reserve days, you still have to pay coinsurance — $704 per day in 2020.
You don’t have to apply all your lifetime reserve days to the same hospital stay. You can split them up as needed. But your hospital will start automatically using your lifetime reserve days when you run through 90 days hospitalization in any benefit period.
If you don’t use your lifetime reserve days after a 90-day hospital stay, you will have to pay the full cost of each day you stay in the hospital going forward.
This coverage is something to take into account if you are considering Medigap coverage. Remember that you cannot have both Medigap and Medicare Advantage coverage at the same time.
5 Cited Research Articles
- U.S. Centers for Medicare & Medicaid Services. (2018, August). Are You a Hospital Inpatient or Outpatient? Retrieved from https://www.medicare.gov/Pubs/pdf/11435-Are-You-an-Inpatient-or-Outpatient.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Inpatient or Outpatient Hospital Status Affects Your Costs. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers/inpatient-or-outpatient-hospital-status
- Barry, P. (2012, October). Medicare: Inpatient or Outpatient? Retrieved from https://docs.google.com/document/u/1/d/1GFmFLLu8BRPSATHx4hAnGXphjSWqhY54bFOCuKQBgH4/edit
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Medicare Part A Coverage – Hospital Care. Retrieved from https://www.medicare.gov/what-medicare-covers/what-part-a-covers/medicare-part-a-coverage-hospital-care
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Inpatient Hospital Care. Retrieved from https://www.medicare.gov/coverage/inpatient-hospital-care