Does Medicare Cover Hospital Stays? 

In the United States, people over 65 years old have the highest rate of inpatient hospital admissions of any other age group. Statistics show that more than a quarter of all inpatient hospital stays every year involve seniors. Seniors typically need inpatient hospital care because of medical emergencies, diagnostic testing, surgical procedures, or intensive treatments for various medical conditions. 

If you’re over the age of 65, or under 65 with a qualifying disability, and enrolled in Medicare, you may want to know more about your coverage for inpatient hospital care. 

How does Medicare cover hospital stays? 

Medicare covers inpatient hospital stays for those who meet the following two eligibility requirements:

1. Your physician makes an official order for your admittance certifying that you require inpatient hospital care to treat an illness or injury. 
2. The hospital accepts Medicare assignment. 

Original Medicare Part A covers the following inpatient hospital expenses and services while you are there for care:

• A semi-private room
• Meals 
• General nursing care  
• Prescription medications that you take as an inpatient
• Other miscellaneous supplies and services necessary for your inpatient care 

Medicare doesn’t cover the following expenses or services you may receive during your inpatient hospital stay:

• Private nursing care 
• A private room unless it’s medically necessary 
• A television or phone in your room 
• Personal care products 

According to Medicare, the inpatient hospital care benefit also covers care that you get in the following medical facilities:

• Long-term care hospitals
• Skilled nursing facilities
• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Psychiatric hospitals (for up to 190 days during your lifetime in a freestanding psychiatric hospital)

Original Medicare Part A also covers inpatient hospital care that is part of a qualifying clinical research study. 

How does Medicare Advantage cover an inpatient hospital stay?

If you are enrolled in a Medicare Advantage (Part C) plan, your provider must cover, at minimum, all benefits included in Original Medicare Parts A and B. Because MA plans are sold by private insurance companies, they have options to include additional coverage and extra benefits, so you may have extended coverage for inpatient hospital stays. 

However, depending on the type of Medicare Advantage plan you’re enrolled in, you may be required to use hospitals or other medical facilities that are listed on your plan’s network of providers to be eligible for coverage. Make sure you check your MA plan’s printed policy or call a plan representative for more information before you are admitted for an inpatient hospital stay. 

How much do you pay for inpatient hospital stays with Medicare insurance? 

Most people receive premium-free Part A based on taxes paid while working, but you’ll still be responsible for paying the Part A deductible. In 2024, the deductible is $1632 per benefit period. 

After meeting your Part A deductible, you pay $0 coinsurance for days 1-60 of your inpatient care. If you stay longer than 60 days, you must pay a daily coinsurance amount. In 2024, you’ll pay $408 coinsurance per day for days 61-90 and $816 coinsurance after day 90 and for each of your 60 lifetime reserve days. If you use all your lifetime reserve days, you pay 100 percent of the cost for all inpatient hospital care.  

If you’re enrolled in Original Medicare Part B, any physician’s services that you receive during your inpatient hospital stay are typically covered by Medicare Part B. Medicare Part B pays 80 percent of the final approved cost for covered services, and you pay the remaining 20 percent after meeting your annual Part B deductible.  

If you have a Medicare Advantage plan, your out-of-pocket charges for copayments or coinsurance depend on the type of Medicare Advantage plan you have. You can get this information by calling a plan representative if you can’t find it on your printed policy or the company’s official website.