How Many Days of Hospitalization Does Medicare Cover?

Medicare, a federal health insurance program, primarily assists individuals aged 65 or older, and certain younger people with disabilities, in managing healthcare expenses. Understanding its provisions, especially concerning hospitalization, is important for financial planning. The program helps cover various medical costs, including hospital stays, but operates under specific rules and limitations that beneficiaries should know.

Medicare Part A Inpatient Hospital Coverage

Medicare Part A provides coverage for inpatient hospital care, which includes services received when formally admitted to a hospital by a doctor’s order. This coverage operates on a “benefit period” system. A benefit period begins the day a patient is admitted as an inpatient to a hospital or skilled nursing facility (SNF) and ends when they have been out of a hospital or SNF for 60 consecutive days. New benefit periods can begin after this 60-day break, potentially requiring a new deductible payment.

For each benefit period, Medicare Part A covers the first 60 days of an inpatient hospital stay after the deductible is met. In 2025, the Part A deductible is $1,676 per benefit period. For days 61 through 90 of an inpatient stay within a single benefit period, a daily coinsurance payment applies, which is $419 per day in 2025. If a hospital stay extends beyond 90 days, Medicare provides an additional 60 “lifetime reserve days” that can be used once over a beneficiary’s lifetime. These lifetime reserve days also require a daily coinsurance payment, set at $838 per day in 2025.

Part A coverage during an inpatient stay includes services such as a semi-private room, meals, general nursing care, medications administered in the hospital, and other necessary services and supplies. It does not cover personal items, private-duty nursing, or a private room unless medically necessary.

Understanding Inpatient and Outpatient Hospital Stays

The classification of a hospital stay as either “inpatient” or “outpatient” impacts Medicare coverage and a patient’s out-of-pocket costs. An inpatient stay begins when a doctor formally admits a patient to the hospital with an official order. This formal admission is the determining factor, not simply the duration of the stay or whether the patient occupies a hospital bed overnight. Outpatient services are those received without a formal inpatient admission, even if they involve an overnight stay in the hospital.

A common outpatient scenario is “observation status,” where a patient remains in the hospital while doctors determine if formal inpatient admission is necessary. While under observation, a patient is considered an outpatient. Part A does not cover observation stays; these services fall under Medicare Part B.

Medicare Part B covers physician services, outpatient hospital services, and drugs received during an observation stay. Patients on observation status are subject to Part B deductibles and coinsurance, which can differ from Part A inpatient costs. Observation days do not count towards the “3-day inpatient hospital stay” requirement for Medicare to cover subsequent skilled nursing facility (SNF) care, which can lead to unexpected costs for patients needing post-hospitalization care.

Skilled Nursing Facility Care After Hospitalization

Medicare Part A provides coverage for skilled nursing facility (SNF) care under specific conditions. To qualify for SNF coverage, a patient must first have a “qualifying inpatient hospital stay” of at least three consecutive days. This means the patient must have been formally admitted as an inpatient for three days in a row, not including the day of discharge. Time spent in the emergency room or under observation status does not count towards this 3-day inpatient requirement.

SNF care covered by Medicare is intended for services requiring skilled nursing or therapy, such as intravenous medications, physical therapy, or wound care, and not for long-term custodial care. The patient must be admitted to the SNF within 30 days of leaving the hospital. Once qualified, Medicare Part A covers the full cost of SNF care for the first 20 days within a benefit period.

For days 21 through 100 of SNF care within the same benefit period, beneficiaries are responsible for a daily coinsurance payment. In 2025, this coinsurance is $209.50 per day. After day 100 in a SNF, Medicare Part A coverage ceases, and the beneficiary becomes responsible for all costs.

How Other Medicare Plans Affect Hospital Costs

Other Medicare plans and supplemental insurance can influence hospital-related costs. Medicare Part B covers many outpatient hospital services not part of an inpatient admission. This includes emergency room visits, laboratory tests, X-rays, and physician services received in a hospital setting. For these Part B-covered services, beneficiaries pay an annual deductible, which is $257 in 2025, followed by a 20% coinsurance of the Medicare-approved amount.

Medicare Advantage (Part C) plans are offered by private insurance companies and provide an alternative way to receive Medicare benefits. These plans are legally required to cover at least everything Original Medicare (Parts A and B) covers. Medicare Advantage plans may have different cost-sharing structures, including varying deductibles, copayments, and coinsurance amounts for hospital stays and skilled nursing facility care. Many Medicare Advantage plans include an annual out-of-pocket maximum, which limits how much a beneficiary pays for covered services in a year.

Medicare Supplement (Medigap) insurance policies are private plans designed to help cover some of the out-of-pocket costs associated with Original Medicare. These policies can pay for expenses like the Part A inpatient hospital deductible, coinsurance for hospital stays (including days 61-90 and lifetime reserve days), and skilled nursing facility coinsurance (days 21-100). Different Medigap plans offer varying levels of coverage for these costs.