Inpatient hospital care (2024)

Medicare Part A (Hospital Insurance) covers inpatient hospital care if you meet both of these conditions:

  • You’re admitted to the hospital as an inpatient after an official doctor’s order, which says you need inpatient hospital care to treat your illness or injury
  • The hospital accepts Medicare

Your costs in Original Medicare

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

In each benefit period, you pay:

  • A $1,632 deductible.
  • Days 1–60: $0 after you meet your Part A deductible.
  • Days 61–90: A $408coinsurance amount each day.
  • After day 90: An $816 coinsurance amount each day while using your 60 lifetime reserve days.

After you use all of your lifetime reserve days, you pay all costs.

Hospitals are now required to include the standard charges for all of their items and services (including the standard charges negotiated by Medicare Advantage Plans) on a public website to help you make more informed decisions about your 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 your inpatient treatment

Medicare doesn't cover:

  • Private-duty nursing
  • Private room (unlessmedically necessary)
  • Television or phone in your room (if there's a separate charge for these items)
  • Personal care items(like razors or slipper socks)

Things to know

Part A only pays for up to 190 days of inpatient psychiatric hospital care in a freestanding psychiatric hospital during your lifetime.

Inpatient hospital careincludes care you get in:

  • Acute care hospitals
  • Critical access hospitals
  • Inpatient rehabilitation facilities
  • Inpatient psychiatric facilities
  • Long-term care hospitals

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

If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctor’s services you get while you’re in a hospital.

Is my test, item, or service covered?

Inpatient hospital care (2024)

FAQs

What does inpatient mean in a hospital? ›

An inpatient is a hospital patient who, in most cases, stays in the hospital overnight and meets a set of clinical criteria. Outpatients are people who receive care or hospital services and return home the same day.

What is the inpatient care process? ›

Inpatient care begins with admission a hospital for intensive monitoring, evaluation, and medical treatment. While in a hospital, an individual may undergo diagnostic tests and procedures to stabilize, diagnose, and treat their active illness.

How many days will Medicare pay for a hospital stay? ›

Days 1–60: $0 after you meet your Part A deductible. Days 61–90: A $408 coinsurance amount each day. lifetime reserve days. In Original Medicare, these are additional days that Medicare will pay for when you're in a hospital for more than 90 days.

What does inpatient mean for Medicare? ›

Your hospital status may also affect whether Medicare will cover care you get in a skilled nursing facility (SNF) following your hospital stay. You're an inpatient starting when you're formally admitted to the hospital with a doctor's order. The day before you're discharged is your last inpatient day.

Why would someone be an inpatient? ›

Inpatient treatment may be done if a person tries to harm themself or others. A person also may go if they have mental illness symptoms, such as seeing or hearing things that aren't there. Or they may go if they are very depressed. Sometimes treatment is done to help people start or adjust medicines.

Can you leave the hospital as an inpatient? ›

You have a right to leave the hospital against the advice of your healthcare providers. Still, you should be aware of the risks of doing so. Hospitals usually decide whether to keep you in care based on valid medical reasons. However, you may decide to leave because of high costs, poor care, or past bad experiences.

Does hospitalized mean overnight? ›

Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care.

What are the 3 parts of the patient care process? ›

The main elements of the patient care process are assessment, development of a care plan, and follow-up. Assessment of the patient (including a complete history and understanding of why they are seeking care) and assessment of current medications are vital to ensure appropriate care is being provided to the patient.

What is the difference between inpatient and outpatient billing? ›

Inpatient utilizes the Inpatient Prospective Payment System (IPPS) and Diagnosis Related Groups (DRGs), while Outpatient operates in the Outpatient Prospective Payment System (OPPS) (CMS, 2022). Outpatient also employs the Ambulatory Payment System (APC).

Does Medicare cover 100% of hospital bills? ›

Medicare doesn't typically cover 100% of your medical costs. Like most health insurance, Medicare generally comes with out-of-pocket costs including copayments, coinsurance, and deductibles. As you'll learn in this article, Original Medicare (Part A and Part B) costs can really add up.

What is the Medicare deductible for inpatient hospital stay? ›

As of 2023, Medicare requires the following out-of-pocket inpatient hospital costs: Deductible of $1,632 for the first day you are a hospital inpatient. This single deductible covers the next 59 days in the hospital for the same benefit period.

What happens when you run out of Medicare hospital days? ›

Medicare will stop paying for your inpatient-related hospital costs (such as room and board) if you run out of days during your benefit period. To be eligible for a new benefit period, and additional days of inpatient coverage, you must remain out of the hospital or SNF for 60 days in a row.

Which part of Medicare helps pay for inpatient hospital care? ›

Medicare Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care.

What is the difference between inpatient and hospitalization? ›

An inpatient may undergo the same treatment as an outpatient, but the outpatient is at the hospital for treatment and then leaves; the inpatient is hospitalized. Does hospitalized mean overnight? A hospitalized person has been admitted to a hospital as an inpatient—usually (but not always) with an overnight stay.

What is the Medicare 30 day readmission rule? ›

CMS (Centers for Medicare and Medicaid Services) defines a readmission in this context as “an admission to a subsection(d) hospital within 30 days of a discharge from the same or another subsection(d) hospital.” Subsection(d) hospitals, per the Social Security Act, include short-term inpatient acute care hospitals ...

What are inpatient days? ›

What are inpatient days? Inpatient days are the days during which patients receive medical services at a facility. This metric is generally calculated based on a daily census spanning a specific time period.

What is another meaning for inpatient? ›

Definitions of inpatient. a patient who is residing in the hospital where he is being treated. synonyms: inmate. antonyms: outpatient. a patient who does not reside in the hospital where he is being treated.

What gets you admitted to the hospital? ›

People are admitted to a hospital when they have a serious or life-threatening problem (such as a heart attack). They also may be admitted for less serious disorders that cannot be adequately treated in another place (such as at home or in an outpatient surgery center).

References

Top Articles
Latest Posts
Recommended Articles
Article information

Author: Catherine Tremblay

Last Updated:

Views: 5439

Rating: 4.7 / 5 (67 voted)

Reviews: 90% of readers found this page helpful

Author information

Name: Catherine Tremblay

Birthday: 1999-09-23

Address: Suite 461 73643 Sherril Loaf, Dickinsonland, AZ 47941-2379

Phone: +2678139151039

Job: International Administration Supervisor

Hobby: Dowsing, Snowboarding, Rowing, Beekeeping, Calligraphy, Shooting, Air sports

Introduction: My name is Catherine Tremblay, I am a precious, perfect, tasty, enthusiastic, inexpensive, vast, kind person who loves writing and wants to share my knowledge and understanding with you.