| If you stay overnight in the hospital, your costs and
coverage will depend on whether you have inpatient status or outpatient status in
the hospital. Staying overnight in the hospital does not make you a
hospital inpatient. You only become an inpatient after your doctor formally
admits you to the hospital.
In general, doctors will only admit you if they expect you
will need to stay at least 2 days overnight in the hospital. Part A covers most of your care when you have inpatient
status.
However, when you are in the emergency room or in the
hospital under observation, you are usually an outpatient. You may be
under observation if
your doctor is keeping an eye on you to decide whether or not to admit you.
Observation services may look and feel exactly like inpatient services.
Observation can last just a few hours or longer. Part B covers your care, including observation services,
when you have outpatient status.
Whether your care gets covered under Part A or Part B
makes a difference. You will likely pay more for
care if it’s considered outpatient rather than inpatient. It also effects
whether you may qualify for Medicare to pay for your stay in a skilled nursing
facility (SNF) after you leave the
hospital. See below for more information.
Your patient status can change during your stay. Ask if
you are an inpatient or outpatient repeatedly. If you are unable to ask this yourself, your family
members and caregivers can ask for you.
Read below to learn about your costs for hospital care as
an inpatient or outpatient. The costs discussed below apply to those with
Original Medicare. If you have a Medicare Advantage plan, your costs in
the hospital may be different. Contact your plan for information about what
you pay for an inpatient or outpatient hospital stay.
Costs for inpatient hospital care
When you are admitted to a hospital as an inpatient, you
pay a one-time deductible for most hospital care provided, and then have
no copayments for
the first 60 days. Medicare Part A covers nurse’s services, medically
necessary medications, X-rays, supplies, appliances, and equipment the
hospital provides for you to use during your inpatient hospital stay.
Medicare Part B covers doctors’ services you receive in the hospital.
You usually owe a separate 20 percent coinsurance for
these doctors’ services.
Your status as a hospital inpatient may qualify you for
Medicare to pay for a SNF stay if you need it after you leave the hospital.
In order to qualify for a Medicare-covered
SNF stay, you must have been a hospital
inpatient for at least 3 days and meet other requirements. The day you become
an inpatient counts toward the qualifying days; the day the hospital
discharges you does not count toward the qualifying days.
Costs and coverage for outpatient hospital care
If you are an outpatient during your hospital stay,
Medicare Part B covers most of your services. You typically pay a coinsurance
for each medical service you receive in the hospital after you meet the Part
B deductible. For example, you will have separate charges for emergency room
care, observation care, x-rays and lab tests. You must also pay the
coinsurance for physician services you receive. Physician services include
any time you spent with a physician while you were in the hospital, even if
that physician was not your primary doctor or surgeon. Original Medicare Part
B generally covers 80 percent of the cost of most services you receive after
you have met your yearly deductible. In most cases, you are responsible for
paying the remaining 20 percent coinsurance.
When Part B covers your hospital care, you may have higher
costs than if Part A covers your stay.
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