Understanding Medicare Coverage for Hospital Stays and Inpatient Care

Whether you’re planning for future healthcare needs or trying to understand bills after a recent hospital stay, knowing what Medicare covers and what it can’t significantly impact your healthcare planning.

Medicare is health insurance for qualifying individuals that may help cover medical expenses, including hospitalization, doctor visits, medical supplies and prescriptions, depending on the coverage you choose. Medicare has several parts, including Part A, Part B and Part D. Medicare Advantage, also called Medicare Part C, is optional and replaces Original Medicare (Part A and B). Medicare Part D may help pay for prescriptions, but it is optional.

Medicare Part A Coverage

Medicare Part A, often referred to as hospital insurance, is primarily responsible for covering hospital stays and inpatient care. Here’s what is typically covered under Medicare Part A:

• Hospital stays—Medicare Part A may help cover inpatient care, including your room, meals, nursing, and other hospital services and supplies. This includes care received in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities and long-term care hospitals.
• Inpatient care in a skilled nursing facility—Coverage may include meals, skilled nursing care, physical and occupational therapy if medically necessary to treat your health condition and other services and supplies after a qualifying 3-day minimum inpatient hospital stay for a related illness or injury.
• Home health care services—Medicare may cover home health care services such as intermittent skilled nursing care, physical therapy, speech-language pathology services, and continued occupational therapy after a hospital stay. A doctor must order these services and a Medicare-approved home healthcare provider must provide them.
• Hospice care—For terminally ill patients who choose palliative care over treatment, Medicare may help cover comprehensive hospice care, including pain relief and symptom management, durable medical equipment and medical, nursing and social services.
• Religious non-medical inpatient healthcare institutions—Medicare may help cover non-religious, non-medical services and items that don’t need a prescription or doctor’s order for people who qualify for skilled nursing facility or inpatient hospital care in these facilities.

Medicare Part A coverage is only for services deemed medically necessary by your healthcare provider and is not for personal care, such as help with eating, dressing or bathing.

Costs Associated with Medicare Part A

While Medicare Part A provides substantial coverage, it does not cover everything. Here are the costs you might expect with a hospital stay:

• Deductibles—For each benefit period, Medicare Part A has a deductible that you must pay before coverage kicks in.
• Coinsurance—Depending on the length of your hospital stay, you may incur coinsurance payments. For example, for hospital stays, Medicare covers the total cost for the first 60 days after you meet your deductible, but days 61-90 require a daily coinsurance payment.
• Supplemental Insurance—Many choose to purchase a Medigap (Medicare supplement insurance) policy to cover gaps in Part A costs like coinsurance and deductibles.

Contact Us

Contact Medicare Line in Colorado Springs, Colorado, to learn more about how Medicare can help cover hospital stays and inpatient care for eligible individuals.

This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.