Does medicare part b pay for hospital stay

The cost of hospital care can be daunting. Fortunately, if you have Medicare Part A (hospital insurance), it generally covers inpatient surgery. Medicare Part B (medical insurance) may cover some services while you’re an inpatient, as well. Here’s how this Medicare coverage works.

What is an inpatient surgery?

Inpatient surgery refers to surgery performed in the hospital after a doctor has admitted you as an inpatient. Your doctor may order an inpatient surgery during a hospital stay or may schedule surgery in advance of your hospital admission.

It is important to understand that you can be getting care in a hospital and still be an outpatient, not an inpatient. Your Medicare coverage and out-of-pocket costs are different for outpatient and inpatient surgery.

When does Medicare cover inpatient surgery?

Your inpatient surgery must meet two basic requirements for Medicare coverage:

• The hospital and physicians performing the inpatient surgery accept Medicare
• Inpatient surgery must be medically necessary. Medicare defines “medically necessary” as “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.”
• In certain cases, the Utilization Review Committee of the hospital approves your stay while you’re in the hospital.

If you’re enrolled in a Medicare Advantage plan, the plan may also require the hospital and doctors providing inpatient surgery to participate in the plan’s provider network as a condition of coverage.

If your inpatient surgery meets Medicare requirements, Medicare Part A and Medicare Advantage plans typically pay for covered hospital services. Hospital services related to inpatient surgery usually include daily room and board, laboratory services, diagnostic tests, surgical equipment and supplies, anesthesia, and the services of doctors, nurses, and other health professionals.

Medicare Part B and Medicare Advantage plans generally cover physician services, including surgeons and anesthesiologists who participate in the inpatient surgery but who are not employees of the hospital.

What can you expect to pay for an approved inpatient surgery?

Medicare Part A generally covers much of the cost related to your inpatient surgery and hospital stay. You may be responsible for a Medicare Part A deductible ($1,600 in 2023) for each benefit period. Medicare defines a benefit period as beginning the day you’re admitted as an inpatient in a hospital or skilled nursing facility (SNF) and ending when you have not received any inpatient hospital or SNF care for 60 days in a row. You pay this inpatient hospital deductible amount for each benefit period.

The amount you may pay for inpatient surgery can also depend on your recovery time. You won’t typically pay a Medicare Part A coinsurance amount if your inpatient stay lasts between one and 60 days. However, if you spend more time in the hospital for inpatient surgery, you have to pay a coinsurance amount.

• You will pay $400 per day (in 2023) per benefit period for days 61 to 90.
• You will be liable for $778 (in 2023) per benefit period for every “lifetime reserve” day you spend in the hospital beyond 90 days.
• If you are still in the hospital after exhausting your “lifetime reserve days,” Medicare Part A generally will not continue coverage for your hospital expenses.

Medicare Part B usually pays 80 percent of the Medicare-approved amount for doctors’ services billed separately from the hospital’s charges for inpatient surgery. You are responsible for 20% after you have met the Part B annual deductible ($226 in 2023).

If you have a Medicare Supplement (Medigap) plan, it may cover some out-of-pocket costs related to your inpatient surgery. All of the Medicare Supplement plans standardized in 47 states may pay the Part A coinsurance on long hospital stays (for an additional 365 days after Medicare coverage is used up). Many also cover all or a portion of Part B coinsurance and Part A and Part B deductibles.

If you have a Medicare Advantage plan, specific inpatient deductibles, coinsurance, and copayments for inpatient surgery may be different from Medicare Part A and Part B cost shares. You can contact the plan’s customer service for coverage information.

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Summary:

Medicare Part A will help cover the costs of hospital care — but depending on the length of your stay, you could be responsible for some big bills if you don’t have supplemental insurance. Here’s what you need to know about Medicare coverage when you’re in the hospital. 

Sooner or later, most of us will need to go to the hospital for some type of treatment. The good news is that if you have Original Medicare or Medicare Advantage, your bills will be at least partially covered under Part A.

But you’ll still have deductibles, coinsurance, and copays to cover out of pocket. And if you have Original Medicare, there’s no maximum on how much you have to spend. Costs can add up quickly, says Caitlin Donovan, a spokesperson for the Patient Advocate Foundation.

That said, there are ways to help offset the fees. Here’s a breakdown of what’s covered — and what isn’t — under Medicare Part A.

What’s included under Medicare Part A?

Medicare Part A helps cover the cost of inpatient hospital care — meaning that a doctor has formally admitted you to a hospital. (Routine testing done at a hospital is considered outpatient care, which is covered under Part B.) It also covers hospice and home health care along with a few other services, says Donovan.

If you’re admitted to a hospital, Medicare Part A will help pay for:

• A semi-private hospital room
• Your meals
• Nursing services
• Medications
• Medical services and supplies needed for inpatient treatment 

Medicare won’t, however, pay for private nursing, personal care items (such as a toothbrush or razor), or a television or phone if it doesn’t come with the room. It also won’t pay for a private room unless it’s medically necessary.

Medicare Part A also covers inpatient psychiatric care in a psychiatric hospital for a total of 190 days in a person’s lifetime.

You can reach licensed eHealth insurance agents at 1-844-869-8318 (TTY: 711), Monday through Friday, 8 a.m. to 9 p.m. ET, and Saturday, 10 a.m. to 7 p.m. ET. Research plans 24/7 online.

What are the out-of-pocket costs for patients using Medicare Part A?

Medicare Part A will help cover your hospital bills, but you may still be responsible for paying for some of the care you receive. The most common fees you’ll pay:

Medicare Part A deductible

If you’re admitted to the hospital, you’ll pay the cost for your care until you meet your Part A deductible. In 2023, that amount is <PART_A_DEDUCTIBLE>* per benefit period

A benefit period starts the first day you’re admitted to the hospital and ends 60 days after your last inpatient day. Once you meet your deductible, Medicare will cover the full cost of your care for the next 60 days.

If you return to the hospital sometime after those 60 days, a new benefit period begins with a new deductible.

Medicare Part A coinsurance

If you’re in the hospital for longer than two months, Medicare will continue to cover the cost of the care, but you’ll also have to pay coinsurance. From Day 61 to Day 90, you’ll pay a coinsurance amount of $278 per day.

Starting on Day 91, you’ll pay a coinsurance amount of $778 for each “lifetime reserve day” you have left. Everyone is granted up to 60 of these days over their lifetime. After those 60 days are over, you’ll be responsible for paying for any additional hospital costs in full.

Because the cost of a lengthy hospital stay can add up to thousands of dollars, Donovan recommends buying supplemental insurance called Medigap (which takes care of the gap in your coverage). “A Medigap plan will cover some of those coinsurance and copay costs,” she says.

How is medication covered under Medicare Part A?

Medicare Part A will cover only the medications you receive as part of your hospital treatment. Otherwise, if you take medication outside of your hospital stay, it would need to be covered by other parts of your health insurance (Part B or Part D).

For example, a limited number of medications are covered by Medicare Part B, including immunosuppressants and certain medications given by injection. For these medications, you’ll pay 20% of the Medicare-approved amount. But unless you have Medicare Part D (Medicare drug coverage), or a Medicare Advantage plan that includes drug coverage, you’ll likely pay the full cost of prescription medication.

Paying for hospital fees with Medicare Part B

Even though you’re being treated in a hospital, that doesn’t mean all the care you receive during your stay will be covered under Medicare Part A. Some tests and services will be covered by Medicare Part B. These include:

• Diabetes equipment and supplies
• Medical equipment, including wheelchairs and walkers
• Screenings, including for cancer
• Tests, including X-rays, MRIs, CT scans, and EKG/ECGs
• Occupational therapy

Under Medicare Part B, you generally pay 20% of the Medicare-approved amount for most doctors’ services you receive at a hospital. Depending on the type of care you receive and the length of your stay, the price tag can be high.

“If you’re just doing Part A and Part B, with no supplemental coverage like a Medigap plan, you’re going to be paying 20% of your expenses,” says Donovan. “And 20% of a very large hospital bill is going to be a lot of money.”

Learn more about Medigap policies and explore your options here.

Finding a nearby hospital that accepts Medicare

Most doctors and hospitals accept Medicare. In fact, only 1% of non-pediatric doctors in the U.S. chose to opt out of Medicare in 2020, according to a report by the Kaiser Family Foundation. What’s more, a report by the American Hospital Association found that the majority of hospitals depend on Medicare or Medicaid payments.

To find a hospital that participates in Medicare, you can visit the Hospital Locator Tool, which allows you to enter your city, state, or ZIP code to find a list of hospitals in your area that accept Medicare. The tool can also sometimes provide details about the quality of care the hospital provides.

For example, some hospitals have a five-star patient survey rating (which measures patients’ satisfaction with their experience at the hospital) and a five-star overall star rating (which measures the hospital’s quality of care).

If you have Medicare Advantage, you’ll want to be sure that your hospital is in your plan’s network. You can do that by checking with your insurance provider.

Ready to get started? Find a plan that fits your budget and covers your doctor and prescription medications now. 

*Amounts are calculated based on 2022 rates.