Your Medicare Coverage

Is my test, item, or service covered?

Inpatient hospital care

How often is it covered?

Medicare Part A (Hospital Insurance) covers hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term care hospitals, inpatient care as part of a qualifying clinical research study, and mental health care.

What's not covered

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

Who's eligible?

All people with Medicare are covered when all of these are true:

  • A doctor makes an official order which says you need 2 or more midnights of medically necessary inpatient hospital care to treat your illness or injury and the hospital formally admits you.
  • You need the kind of care that can be given only in a hospital.
  • The hospital accepts Medicare.
  • The Utilization Review Committee of the hospital approves your stay while you're in the hospital.

Your costs in Original Medicare

  • $1,216 deductible for each benefit period ($1,260 in 2015).
  • Days 1–60: $0 coinsurance for each benefit period ($0 in 2015).
  • Days 61–90: $304 coinsurance per day of each benefit period ($315 in 2015).
  • Days 91 and beyond: $608 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime) ($630 in 2015).
  • Beyond lifetime reserve days: all costs.
Note

You pay for private-duty nursing, a television, or a phone in your room. You pay for a private room unless it's medically necessary.

Note

The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, your total copayment for all outpatient services may be more than the inpatient hospital deductible.

 

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. It’s important to ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.

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