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Hospitals and Medicare

Most of us need hospital care at some point in our lives. It's important to understand what type of Medicare hospital coverage you're eligible for, and what benefits you're entitled to, under Original Medicare (Part A and Part B).

About hospitals

Hospitals provide treatment, usually for serious illnesses or injuries, through specialized staff and equipment. They are staffed by physicians, surgeons, and nurses.

Many doctors are connected with hospitals, even doctors who have private practices elsewhere. If your doctor decides you need to go to the hospital, in many cases he or she will send you to the one the doctor is connected with.

Most patients who need hospital services are admitted for a relatively short stay. Long-term hospitals are usually rehabilitation centers, psychiatric hospitals, or facilities that specialize in certain diseases.

Eligibility for hospital coverage

Medicare will cover your hospital stay if you meet all of these requirements:

  • You are enrolled in Medicare Part A.

  • Your participating Medicare doctor orders inpatient hospital care for your illness or injury.

  • The care you need requires a hospital stay.

  • You go to a hospital that participates in Medicare.

  • Your stay is approved by the hospital's Utilization Review Committee during your hospital stay.

Medicare benefits for hospital stays

Most Medicare hospital coverage is provided through Medicare Part A and some by Medicare Part B.

Medicare Part A: If you're admitted to the hospital as an inpatient, Medicare hospital coverage generally includes (but isn't limited to):

  • A semi-private (shared) room

  • Meals

  • Nursing care

  • Drugs given as part of your treatment

Medicare Part B: While Medicare Part A is the main hospital coverage arm of Medicare, some services are covered through Medicare Part B. Most beneficiaries have Original Medicare (Part A and Part B) coverage, but some do not have Medicare Part B. If you don't know whether you have Medicare Part B, look at your Medicare card. You can also call 1800-MEDICARE and ask.

Medicare Part B may cover services and supplies such as:

  • Ambulance transportation

  • Durable medical equipment, like walkers

  • Doctor visits

  • Second opinions on surgeries

  • Lab tests

  • X-rays and other scans

Hospital services not covered by Medicare

Original Medicare, Part A and Part B, doesn't cover the costs of private-duty nursing, a phone or television, personal items (like toothpaste), or a private room (unless a private room is medically necessary).

Medications

Original Medicare, Part A and Part B, generally covers drugs given to you during your hospital stay.

If you're an outpatient, Medicare doesn't usually 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.

Costs and benefits for hospital services

Under Medicare Part A, your costs for an inpatient hospital stay include:

  • 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.

  • All costs for each day after you've used all of your lifetime reserve days.

Under Medicare Part B:

  • In general, you pay 20% of the Medicare-approved amount for most doctor services you receive when you're a hospital inpatient or outpatient.

  • For hospital outpatient services, you 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.

Medicare has neither reviewed nor endorsed this information.

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