Medicare Coverage and Hospital care
Medicare and Hospitals
It may not be something you like to think about but sometimes you may find yourself needing hospital care. Knowing what Medicare will cover ahead of time for this kind of treatment can put your mind at ease. All the plans, Original Medicare, Part A and Part B, all offer different hospital coverage.
You can get inpatient and outpatient care staffed by physicians, surgeons, and nurses. These are the types of facilities that offer care:
- Long-term care hospital
- Acute care hospital
- Critical access hospital
- Inpatient rehabilitation facility
- Qualifying research study
- Psychiatric hospital
Inpatient hospital care
The length of your hospital stay can vary when you need inpatient hospital care. Your doctor or surgeon will decide based on the seriousness of your condition and the type of care you need.
Medicare Part A covers inpatient hospital care when these conditions are met:
- You are enrolled in Medicare Part A.
- An official doctor orders you to be admitted to the hospital and says you need inpatient hospital care to treat your illness or injury
- The hospital accepts Medicare
- The Utilization Review Committee approves your stay while you're in the hospital.
- The care you need requires a hospital stay
Services covered by Medicare include:
- Semi-private rooms
- Drugs as part of your inpatient treatment
- Other hospital services and supplies
Long-term care hospitals
If your hospital stay isn't quick, you may find you're transferred to a long-term care hospital, so you'll have more time to recover. Long-term care hospitals treat people with serious conditions and may offer specialized rehabilitative, trauma, and pain management services.
Medicare Part B covers services and supplies such as:
- Ambulance transportation
- Durable medical equipment, like walkers
- Doctor visits
- Preventive services
- Second opinions on surgeries
- Lab tests
- X-rays and other scans
Medicare benefits for hospital stays
If you're admitted to the hospital as an inpatient, Medicare Part A will cover you. If you need outpatient surgery, observation services, or other doctor services in a hospital, Medicare Part B will cover you. If a hospital hasn't formally admitted you as an inpatient, just because you stay overnight doesn't mean you have an inpatient status.
Hospital services not covered by Medicare
- Private-duty nursing
- Phone or television
- Personal items (like toothpaste)
- A private room (unless it's medically needed)
Drugs given to you during your inpatient hospital stay are usually covered by Medicare Part A. Limited prescription drugs given in a hospital outpatient setting or a doctor's office are usually covered by Medicare Part B.
Medicare doesn't usually cover prescription drugs that you can "self-administer" (take by yourself) in an outpatient situation. A stand-alone Medicare Prescription Drug Plan (Part D) or a Medicare Advantage Prescription Drug plan may cover these. Talk to someone at your Medicare plan for more information.