Original Medicare (Parts A & B): Inpatient Hospital Care

What it is

Medicare-covered inpatient hospital services include:

• Semi-private rooms

• Meals

• General nursing

• Drugs (including methadone to treat an opioid use disorder)

• Other hospital services and supplies as part of inpatient treatment

Medicare doesn't cover:

• Private duty nursing

• Private room (unless medically necessary)

• Television or phone in your room (if there is a separate charge for these items)

• Personal care items (razors, briefs, slipper socks)

Things to know

Inpatient hospital care includes care provided in:

• Acute care hospitals

• Critical access hospitals

• Inpatient rehabilitation facilities

• Inpatient psychiatric facilities

• Long-term care hospitals

It also includes inpatient care provided as part of a qualifying clinical research study.

Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime.

Religious non-medical healthcare institution (inpatient care). If your loved one qualifies for inpatient hospital or skilled nursing facility care in one of these facilities, Medicare will only cover inpatient, non-religious, non-medical items and services, like rooms and board, and items or services that do not need a provider order or prescription (like unmedicated wound dressings or use of a simple walker). Medicare does not cover the religious portion of this type of care.

Together with Part B, generally 80% of the Medicare-approved amount for provider services received while in a hospital is covered.

Costs

For each benefit period*, your loved one is responsible to pay:

• $1,600 deductible

• $0 for admission Days 1 - 60

• $400 copayment each day for admission Days 61-90

• $800 copayment per each "lifetime reserve day" after Day 90 (up to 60 days in a lifetime)

• All costs for each day after the 60 lifetime reserve days

Note that lifetime reserve days do not reset; once they are spent, they are deducted from the 60 days total until gone.

Blood

Blood transfusion is necessary for a number of planned and unplanned circumstances and can mean the difference between life and death. There are circumstances when blood transfusion is at no cost, though it is likely your loved one will be charged for the first 3 units.

If the hospital gets blood from a blood bank at no charge, those savings are passed on to your loved one and there are no replacement fees. Likewise, if your loved one or someone else donates the blood (such as a family member who is a match), there is no cost.

However, if the hospital must purchase blood for your loved one, they will pay the hospital costs for the first 3 units in a calendar year.

Inpatient hospital insurance tips

The primary care provider or other healthcare provider may recommend services more often than Medicare covers, or they may recommend services that Medicare doesn't cover. If this happens, your loved one may be responsible for some or all of the costs. Ask questions so you both understand why the provider is recommending certain services and if, or how much, Medicare will pay for them.

Hospitals are now required to make public the standard charges for all of their items and services (including the standard charges negotiated by Medicare Advantage plans) to assist in making more informed decisions about care.

*BENEFIT PERIOD: There is no limit to the number of benefit periods. A "benefit period" starts on the day of admission to a hospital or skilled nursing facility. It ends after 60 days in a row without hospital or skilled nursing care. Upon hospital admission, after one benefit period has ended, a new benefit period begins.