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Hospitals and Medicare

About hospitals

Hospitals provide patients treatment through specialized staff and equipment. Hospitals can be funded several ways: by the public sector, health organizations (for-profit or nonprofit), health insurance companies, or by charities, including direct charitable donations. Historically, hospitals were often founded, funded and operated by religious orders or charitable individuals and leaders. Hospitals are largely staffed by professional physicians, surgeons and nurses.

According to an American Hospital Association survey, in 2010 there were 5,754 registered U.S. hospitals equipped with 941,995 staffed beds. There were 36.9 million admissions in these hospitals, and expenses totaled $750.6 billion.

Most patients who need hospital services are admitted for a relatively short stay. Short-stay hospitals include community, teaching and public hospitals:

  • Most community hospitals offer emergency services, as well as a range of inpatient and outpatient medical and surgical services.
  • Teaching hospitals are those hospitals affiliated with medical schools, nursing schools, or allied-health professions training programs. Teaching hospitals are the primary sites for training new physicians, and interns and residents work there under the supervision of experienced physicians.

Long-term hospitals are usually rehabilitation and psychiatric hospitals, or facilities that treat tuberculosis or other pulmonary (respiratory) diseases.

Medicare coverage of hospitals

If you're admitted to the hospital as an inpatient, Medicare Part A will help cover your stay. This would generally include a semi-private room, meals, general nursing care, drugs and other hospital services and supplies you receive during your inpatient stay. It doesn't include doctors' services. Part B, however, helps cover some of the doctors' services you receive as an inpatient. Note: Medicare measures your use of inpatient hospital care and skilled nursing facility (SNF) services in "benefit periods." A benefit period begins the day you're admitted as an inpatient to a hospital or skilled nursing facility (SNF), and ends when you haven't had any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. You can have more than one hospital stay within the same benefit period. There's a limit on how many days Medicare covers during a benefit period, but there's no limit on the number of benefit periods you can have over your lifetime. Part B also helps cover such outpatient services as doctors' services, emergency and observation services, lab tests and X-rays. Remember, staying overnight in a hospital doesn't always mean you're an inpatient.

What do you pay for hospital services?

If you have Part A, you pay the following for an inpatient hospital stay:

  • A one-time hospital deductible, but no coinsurance for days 1-60 during each benefit period.
  • A coinsurance amount per day for days 61-90 during each benefit period.
  • A coinsurance amount for each "lifetime reserve day". You may choose to use these lifetime reserve days after day 90 of each benefit period. You have a total of 60 lifetime reserve days over your lifetime.
  • All costs for each day after you've used all of your lifetime reserve days.

If you have Part B, in general, you pay 20 percent of the Medicare-approved amount for most doctor services you receive when you're a hospital inpatient or outpatient. For hospital outpatient services, you generally pay a copayment for each individual outpatient hospital service. The copayment can be different for each service but never more than the Part A hospital deductible. In some cases, your total copayments for all covered hospital outpatient department services may be more than the inpatient hospital deductible.

Hospital services not covered by Medicare

Medicare doesn't cover the cost of private-duty nursing, a phone or television, personal items (like toothpaste), or a private room unless medically necessary. If you're an outpatient, Part B generally doesn't cover the prescription drugs that you can "self administer" (take by yourself). If you have a Medicare Prescription Drug Plan (Part D), these drugs may be covered under certain circumstances. Call your plan for more information, or visit www.medicare.gov/publications to view or print the publication "How Medicare Covers Self-Administered Drugs Given in Hospital Outpatient Settings."

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Medicare has neither reviewed nor endorsed this information.