Medicare Your Coverage Options

What to know about Medicare inpatient hospital care

Written by Diane Archer

Medicare Part A covers medically reasonable and necessary inpatient hospital care and discharge planning. Be sure to speak to your doctor to ensure you are formally admitted as an inpatient, since hospitals often classify people with Medicare as outpatients. And, plan ahead, if possible. Be sure to bring along a buddya friend or family member who can be your advocate while you are in hospital.

Too often, the hospital treats Medicare patients as outpatients, even if they stay overnight for a few days. Patients are generally unaware of the difference since Medicare Part B covers outpatient hospital care. But, getting outpatient observation care may leave patients with huge health care bills without their knowledge.

People who will need inpatient nursing or rehab care after they leave the hospital particularly want to be sure they are admitted as inpatients. Unless you are admitted as a hospital inpatient for at least three days in the 30 days prior to admission to a skilled nursing facility or rehabilitation facility, Medicare will not cover your care in these facilities.

What does Part A cover?  If you are enrolled in traditional Medicare, Medicare Part A covers the full cost of a semi-private room and meals, nursing care, medications and medical supplies for 60 days, after you or your supplemental insurance pays the deductible ($1,340 in 2018)Please note that Medicare Part A does not cover a private nurse, a private room, or any non-medical supplies or services, such as telephones or televisions in your room. Medicare Part B covers your medical services. 

Beginning on day 61 up until day 90, if you do not have supplemental insurance–Medigap, retiree coverage or Medicaid–you must pay daily coinsurance ($335 in 2018).

If you are enrolled in a Medicare Advantage plan, check with your plan about your out-of-pocket costs. Each plan differs.

Here’s a list of what you should bring to the hospital. And, to make sure you get the care you need, here’s a list of the seven things you should do before going to the hospital.

Once you are ready to leave the hospital, you are entitled to a hospital discharge plan, laying out where you are going–e.g., home, a nursing facility or a rehabilitation facility–along with the care you will need, who will provide your care, and a list of your medications. If you are returning home, make sure the hospital arranges for home health care, if you will need it, as well as any other services you may need.

The hospital should also let you know which services Medicare covers and which services you will be responsible for paying for once you leave the hospital. Finally, you or your caregiver should be given hospital staff contact information if issues arise after you leave. Click on this Just Care post for a list of the seven things you should be sure to do before leaving the hospital.

Here’s more from Just Care:


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