What Does Medicare Cover for Hospital Stays?

Medicare is a federal health insurance program for individuals aged 65 or older, and for some younger people with specific disabilities. It provides coverage for various healthcare services, including hospital stays. Understanding Medicare’s hospital coverage is important for beneficiaries to navigate their healthcare needs and financial responsibilities, helping them prepare for potential costs and ensure appropriate care.

Medicare Part A Hospital Inpatient Coverage

Medicare Part A, often referred to as hospital insurance, covers inpatient hospital care. This includes services such as a semi-private room, meals, general nursing, and other hospital services and supplies. For coverage, a doctor must formally order inpatient admission, confirming medical necessity. The hospital must also accept Medicare.

A “benefit period” is a key feature of Medicare Part A coverage. It begins when a beneficiary is admitted as an inpatient to a hospital or skilled nursing facility (SNF) and ends after 60 consecutive days without inpatient or SNF care. A new benefit period, with a new deductible, begins if readmitted after 60 consecutive days. This allows for multiple benefit periods and deductibles within a year.

Services Included During a Hospital Stay

When Medicare Part A covers an inpatient hospital stay, it includes various services. This includes a semi-private room and meals. General nursing care is also covered, ensuring patients receive continuous medical attention.

Medicare Part A also covers various medical services and supplies during the inpatient period. This includes laboratory tests, X-rays, and MRI scans. Operating room and recovery room services are covered for surgical procedures, along with medications. Medical supplies, such as bandages, are also included. Rehabilitation services like physical or occupational therapy are covered if required.

Your Financial Responsibilities

While Medicare Part A provides substantial coverage for inpatient hospital stays, beneficiaries are responsible for certain out-of-pocket costs. For each benefit period, a deductible applies before Medicare begins to pay. In 2025, this inpatient hospital deductible is $1,676. This amount covers the beneficiary’s share of costs for the first 60 days of Medicare-covered inpatient hospital care within that benefit period.

For longer hospital stays, daily coinsurance amounts come into effect. For days 61 through 90 of a benefit period, the coinsurance amount is $419 per day in 2025. Should an inpatient stay extend beyond 90 days, beneficiaries can utilize “lifetime reserve days.” Each beneficiary has a total of 60 lifetime reserve days that can be used over their entire life. For each lifetime reserve day used, the daily coinsurance in 2025 is $838. Once these 60 lifetime reserve days are exhausted, the beneficiary becomes responsible for all hospital costs for any subsequent days beyond 90 in a benefit period.

Certain costs are generally not covered by Medicare Part A during a hospital stay. These exclusions include the cost of a private room unless it is medically necessary. Private duty nursing, where a patient hires their own dedicated nurse, is also not covered. Personal items such as toiletries, a television, or a telephone in the room are typically not covered if they are separate charges.

Inpatient Versus Observation Status

A distinction exists between being admitted as an “inpatient” and being placed under “observation status” in a hospital. This classification impacts Medicare coverage and a beneficiary’s financial responsibilities. An inpatient admission occurs when a doctor formally orders it, determining that the patient requires medically necessary hospital care, often expected to span two or more midnights. In this scenario, services are covered under Medicare Part A.

Conversely, observation status is considered an outpatient service, even if the patient stays overnight in a hospital bed. This status is used while doctors evaluate whether a patient needs to be admitted as an inpatient or can be discharged. Services received under observation status are covered under Medicare Part B, not Part A. This difference means that instead of paying the Part A deductible, beneficiaries under observation status are subject to the Part B annual deductible, which is $257 in 2025, and generally a 20% coinsurance for each covered service received.

The distinction also has implications for eligibility for Medicare coverage of a Skilled Nursing Facility (SNF) stay. To qualify for Medicare Part A coverage of an SNF stay, a beneficiary typically needs to have had a qualifying inpatient hospital stay of at least three consecutive days. Time spent under observation status does not count towards this three-day inpatient requirement. Therefore, patients discharged from a hospital after only being under observation status would not meet the criteria for Medicare-covered SNF care, potentially leading to substantial out-of-pocket costs for post-hospital rehabilitation or skilled care.