What is Hospital Indemnity Insurance?
Hospital indemnity insurance is an additional insurance policy you can buy that pays you a fixed amount for each day you spend in a hospital. It can help cover out-of-pocket hospitalization costs that Original Medicare or a Medicare Advantage plan will not.
How Does Hospital Indemnity Insurance Work?
Hospital indemnity insurance is sold by private insurance companies and can help you cover your out-of-pocket hospital costs not covered under Medicare or Medicare Advantage.
Original Medicare and Medicare Advantage plans have limitations to the amount they will pay toward hospital stays.
Original Medicare covers 90 days hospitalization with an additional 60 days that include high coinsurance — $352 per day in 2020 — that you have to pay out of your own pocket.
Observation Hospital Stays
If your doctor hospitalizes you for observation, Medicare will generally not cover that hospital stay. The costs of an observation stay can add up quickly and you may be responsible for paying the full amount.
Hospital indemnity insurance can help cover those costs. When you purchase these private policies, you choose how much daily coverage you want.
The more coverage you want, the higher your premiums. If you are hospitalized, the policy pays an agreed upon rate for each day you’re in the hospital.
Types of Hospital Indemnity Insurance Coverage
Different hospital indemnity insurance plans offer benefits beyond inpatient hospitalization. These options may cost more, but they can cover out-of-pocket costs for specific situations your Original Medicare or Medicare Advantage may not.
It’s important to consider what options you want and whether or not your other plans cover what you believe you will need in the future.
Be sure to ask for the options you think you will need and compare supplemental insurance if you are considering an indemnity plan.
- Emergency Care Before Hospitalization
- Some indemnity plans cover visits to urgent care or emergency rooms and ambulance transport that end up as inpatient hospitalization. Coverage is usually a lump-sum cash payment for each service.
- Family Assistance During Hospitalization
- Options may include daily payment for transport and lodging for family members to be near you when you are hospitalized.
- Treatment After Hospitalization
- If you need additional treatment after you’re discharged from the hospital, this option can help cover out-of-pocket costs for physical therapy or other therapy. It can also cover your stay in a skilled nursing facility.
- Outpatient Hospitalization (Observation)
- Medicare and Medicare Advantage plans consider observation care as outpatient hospitalization and pay different amounts than for inpatient hospitalization. An indemnity plan can help cover the gap in what you have to pay.
Hospital Indemnity Insurance for Medicare Advantage
Medicare Advantage plans may impose additional out-of-pocket costs if you have an accident, long-term illness or other hospital stay. You may face large copays for your first few days in the hospital. Your deductibles, copayments and coinsurance can add up quickly.
Your maximum out-of-pocket (MOOP) expenses can be $3,000 to $10,000 for a hospital stay.
Hospital indemnity insurance pays you a fixed amount for each day you’re hospitalized to help offset your MOOP.
But hospital indemnity is not for everyone on Medicare Advantage. You should look closely at your Medicare Advantage plan and compare it to the indemnity plan you are considering to see if it fits your needs.
- Cost of Hospital Stays
- In addition to an average cost of $2,500 per day for a hospital stay, consider that in 2012, the average stay lasted 4.5 days according to the Healthcare Cost and Utilization Project.
- Your Health
- Consider your general health and whether you might require a hospital stay. Consider the chances of accidents, any chronic conditions and unexpected health issues based on age and family history.
- Your Finances
- Think about how you would be able to afford a hospital stay that isn’t covered by Original Medicare or Medicare Advantage and how that might affect your financial security.
- Look carefully at the gaps in your Medicare or Medicare Advantage plan’s hospitalization coverage and determine how much daily coverage you might need to fill those gaps based on your needs.
7 Cited Research Articles
- Ellison, A. (2019, January 4). Average Hospital Expenses per Inpatient Day Across 50 States. Retrieved from https://www.beckershospitalreview.com/finance/average-hospital-expenses-per-inpatient-day-across-50-states.html
- Kaiser Family Foundation. (2019). Hospital Adjusted Expenses Per Inpatient Day. Retrieved from https://www.kff.org/health-costs/state-indicator/expenses-per-inpatient-day/
- U.S. Centers for Medicare & Medicaid Services. (2018, December). Medicare and Other Health Benefits: Your Guide to Who Pays First. Retrieved from https://www.medicare.gov/Pubs/pdf/02179-medicare-coordination-benefits-payer.pdf
- Healthcare Cost and Utilization Project. (2014, October). Statistical Brief #180; Overview of Hospital Stays in the United States, 2012. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). How Medicare Works With Other Insurance. Retrieved from https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Retiree Insurance. Retrieved from https://www.medicare.gov/supplements-other-insurance/retiree-insurance
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Inpatient Hospital Care. Retrieved from https://www.medicare.gov/coverage/inpatient-hospital-care