Medicare coverage for hospital stays
Medicare Part A, the first part of original Medicare, is hospital insurance. It typically covers inpatient surgeries, bloodwork and diagnostics, and hospital stays.
Part A also includes coverage for:
- blood transfusions when done during a hospital stay
- limited skilled nursing facility care
- limited home healthcare
- hospice care
If admitted into a hospital, Medicare Part A will help pay for:
- the hospital room
- nursing services
- medical supplies
- durable medical equipment used while in hospital care, like wheelchairs, walkers, and crutches
- diagnostic testing
- rehabilitation services provided while an inpatient
Even with insurance, youâ€™ll still have to pay a portion of the hospital bill, along with premiums, deductibles, and other costs that are adjusted every year.
In 2020, the Medicare Part A deductible is $1,408 per benefit period.
Medicare Part A deductible
Unlike some deductibles, the Medicare Part A deductible applies to each benefit period. This means it applies to the length of time youâ€™ve been admitted into the hospital through 60 consecutive days after youâ€™ve been out of the hospital.
So, if youâ€™re discharged from the hospital and return within the 60-day period, you donâ€™t need to pay another deductible.
If youâ€™re admitted after the 60-day period, then youâ€™ve started another benefit period and you will be expected to pay another deductible.
Medicare Part A coinsurance
Once the deductible is paid fully, Medicare will cover the remainder of hospital care costs for up to 60 days after being admitted.
If you need to stay longer than 60 days within the same benefit period, youâ€™ll be required to pay a daily coinsurance. The coinsurance applies to an additional 30-day period â€” or days 61 through 90 if counted consecutively.
As of 2020, the daily coinsurance costs are $352.
After 90 days, youâ€™ve exhausted the Medicare benefits within the current benefit period. At that point, itâ€™s up to you to pay for any other costs, unless you elect to use your lifetime reserve days.
A more comprehensive breakdown of costs can be found below.
What are lifetime reserve days?
Medicare provides an additional 60 days of coverage beyond the 90 days of covered inpatient care within a benefit period. These 60 days are known as lifetime reserve days.
Lifetime reserve days can be used only once, but they donâ€™t have to be used all in one hospital visit. For example, if you have two extended hospital stays, each amounting to 120 days, you can use 30 lifetime reserve days for each period.
Using lifetime reserve days will come at a higher cost or coinsurance. The 2020 coinsurance cost for these days is $704.
Other costs for Medicare Part A
If you paid Medicare taxes during your working years, you may qualify for premium-free Medicare Part A. To be eligible, youâ€™ll need to have worked for 40 quarters, or 10 years, and paid Medicare taxes during that time.
If you havenâ€™t met that benchmark and have to pay monthly premiums, you can expect to pay $458 per month in 2020.
Other options for hospital coverage
Another option for hospital coverage is a Medicare Advantage (Part C) plan. These plans are offered through private providers and include all benefits covered through original Medicare (Part A and Part B).
These plans often include extra benefits, too, such as Medicare Part D (prescription drug coverage). They may also offer coverage for:
- health perks like fitness memberships
Another option is to add a Medigap plan to your Medicare coverage. Like Medicare Advantage plans, these are offered through private insurance providers and can help provide additional coverage toward coinsurance or deductible costs.
Itâ€™s important to note that you canâ€™t have a Medicare Advantage (Part C) plan and a Medigap plan at the same time; you can only choose one or the other.
Itâ€™s a good idea to add up all of your set and expected costs before selecting a plan. A Medicare agent can help you better understand your options and anticipated expenses.
Medicare Part A can assist with inpatient care costs, but only for a specific time period.
If you or a family member anticipate an extended hospital stay for an underlying health condition, treatment, or surgery, take a look at your insurance coverage to understand your premiums and to analyze your costs.
Though Medicare provides coverage for some of your hospital stay, youâ€™ll be expected to pay for a portion of the bill.
Read more on: medicare