Key Takeaways

• Medicare covers a wide range of hospital-related services, but coverage depends on your eligibility, the type of care you receive, and how long you’re in the hospital.

• Understanding what Medicare doesn’t cover during a hospital stay can help you prepare financially and avoid unexpected costs.

What Happens When You’re Admitted to the Hospital Under Medicare?

If you’re enrolled in Medicare and find yourself admitted to the hospital, it’s natural to wonder what your benefits actually cover. Whether your stay is due to an illness, surgery, or observation, Medicare coverage kicks in differently based on the type of admission, length of stay, and medical services received.

Inpatient vs. Observation Status

The first distinction Medicare makes is between inpatient and outpatient (also called observation status) care:

• Inpatient care means you’re formally admitted to the hospital with a doctor’s order. Medicare Part A generally covers this.

• Observation care, even if you’re staying overnight, is considered outpatient. Medicare Part B usually applies here.

This classification affects your out-of-pocket costs and eligibility for follow-up services, such as skilled nursing facility care.

What Medicare Part A Covers During Inpatient Stays

When you’re officially admitted as an inpatient, Medicare Part A will usually help cover:

• Semi-private room accommodations

• Meals provided during your stay

• General nursing care

• Medications administered in the hospital

• Other hospital services and supplies (such as operating room use, lab tests, and rehabilitation services)

Time Limits and Benefit Periods

Coverage under Part A operates on a benefit period, which begins the day you’re admitted and ends when you haven’t received inpatient care for 60 days in a row. You can have multiple benefit periods in a year.

For 2025:

• You must pay a deductible at the beginning of each benefit period.

• Coinsurance kicks in after 60 days of inpatient care.

Medicare will pay in full for the first 60 days (after the deductible), but you’ll be responsible for daily coinsurance starting on day 61 through day 90, and higher amounts for any lifetime reserve days beyond that.

What Medicare Part B Covers in a Hospital Setting

Even during an inpatient stay, some services are billed under Medicare Part B. These include:

• Doctor’s visits and medical consultations

• X-rays, MRIs, and other diagnostic services

• Outpatient surgeries and emergency room visits before admission

Part B also covers outpatient hospital services when you’re in observation status.

Skilled Nursing Facility (SNF) Coverage After a Hospital Stay

Medicare will only help cover care in a skilled nursing facility if you meet certain requirements:

• You must have had a qualifying inpatient hospital stay of at least three consecutive days (not counting the discharge day).

• Your doctor must certify that you need daily skilled care.

• You must enter the SNF within a short time (generally within 30 days) after leaving the hospital.

What’s Covered in a SNF

Medicare covers:

• Semi-private room

• Meals

• Skilled nursing services

• Physical and occupational therapy

• Medical social services

SNF stays are also subject to benefit periods and daily coinsurance beyond the first 20 days.

What Medicare Will NOT Cover During a Hospital Stay

Understanding Medicare’s limitations is just as important as knowing what it covers. During your hospital stay, Medicare won’t cover:

• Private-duty nursing

• Television or phone charges in your room (if charged separately)

• Personal care items, such as razors, socks, or magazines

• Private rooms, unless deemed medically necessary

• Non-medically necessary services, even if requested

If you’re placed under observation status, you may also be surprised to find that some follow-up care isn’t covered the way you’d expect. For example, you might not qualify for SNF coverage, even after a multi-day hospital stay.

What About Hospital Readmissions?

If you’re discharged and then readmitted to the hospital within 60 days, you’re still within the same benefit period. This means:

• You won’t need to pay another Part A deductible

• Your coinsurance clock will continue based on the total number of inpatient days

If more than 60 days have passed, a new benefit period begins, and you’ll be responsible for another Part A deductible.

Emergency Room Visits and Observation Status

Even if you spend a night (or more) in the hospital, you may still be classified under observation status, especially if you entered through the emergency department.

• Observation care is billed under Part B, not Part A.

• You’ll typically owe 20% of the Medicare-approved amount for each outpatient service after your Part B deductible is met.

This classification is important because it may affect what services you can receive after discharge—especially SNF care.

Preparing Financially for Hospitalization

Since Medicare doesn’t cover everything, it’s wise to plan for potential out-of-pocket costs. Consider the following:

• Review your coverage before hospital admission when possible.

• Be aware of Part A and Part B deductibles and coinsurance.

• Ask if your admission status is inpatient or observation—this affects your cost and eligibility for follow-up care.

You can also consider supplemental options (not discussed here) to help with costs Medicare doesn’t pay.

The Role of Advance Beneficiary Notices (ABNs)

Hospitals are required to give you an Advance Beneficiary Notice of Noncoverage (ABN) if they believe Medicare may not cover a certain service.

The ABN:

• Lists the services and items in question

• Explains why Medicare might not pay

• Asks whether you want to receive the service anyway and accept financial responsibility

Always read ABNs carefully and ask questions if anything is unclear.

Hospital Discharge and Follow-Up Care

Once you’re discharged, Medicare may continue to help cover certain services, including:

• Home health care, if prescribed

• Durable medical equipment (DME), such as walkers or oxygen

• Skilled nursing care, if you meet the requirements

• Outpatient follow-up visits with your doctor

However, any services not deemed medically necessary may not be covered, even if recommended.

Tips to Make the Most of Your Medicare Coverage

To help ensure that you get the benefits you’re entitled to:

• Always ask whether your status is inpatient or outpatient

• Keep track of your benefit periods and hospital days used

• Request itemized bills to spot potential errors

• Speak to a discharge planner or case manager before leaving the hospital

• Know your rights to appeal coverage decisions or denials

Staying informed helps you avoid unnecessary costs and take full advantage of your Medicare benefits.

Know What to Expect From Medicare During a Hospital Stay

Being admitted to the hospital is stressful enough without added confusion over Medicare coverage. The key is knowing where Medicare draws the line—what it helps pay for, what it leaves up to you, and how to ask the right questions.

Make sure you’re not caught off guard by unexpected costs or denied services. If you’re unsure how your coverage applies to your specific situation, get in touch with a licensed agent listed on this website for professional advice and peace of mind.