How Long Will Medicare Pay for a Hospital Stay?
This article was updated on: 09/12/2018
Have you been concerned about how long Medicare will pay for a hospital stay? You might think that the Medicare Part A deductible is an annual cost, tied to the year. In fact, it’s tied to the Part A “benefit period,” which means it’s possible to have to pay the Part A deductible more than once within a year.
How does Medicare cover hospital stays?
When it comes to hospital stays, Medicare Part A (hospital insurance) generally covers much of the care you receive:
- As a hospital inpatient
- In a skilled nursing facility (SNF)
You generally have to pay the Part A deductible before Medicare starts covering your hospital stay. Some insurance plans have yearly deductibles – that means once you pay the annual deductible, your health plan may cover your medical services for the rest of the year. But under Medicare Part A, you need to pay the deductible once per benefit period.
What’s a benefit period for a hospital stay or SNF stay?
A benefit period is a timespan that starts the day you’re admitted as an inpatient in a hospital or skilled nursing facility. It ends when you haven’t been an inpatient in either type of facility for 60 straight days.
Here’s an example of how Medicare Part A might cover hospital stays and skilled nursing facility (SNF) stays if you have more than one of these in the same year.
|January||You’re admitted for a hospital stay as an inpatient January 10.
|Y||N||No coinsurance for first 60 days|
|February||You’re released from the hospital and admitted to a skilled nursing facility (SNF) February 5.
You’re released from the SNF February 23.
|Y**||N||There’s no coinsurance for the first 20 days in a skilled nursing facility.*|
|March||No hospital or SNF stay|
|June||You’re admitted for a hospital stay June 4 (either for the same condition or a different one).
You’re released from the hospital June 22.
|Y||N||More than 60 days have passed since you got out of the skilled nursing facility – so you begin a new benefit period for this hospital stay.
· Part A deductible(start paying all over again)
· No coinsurance for first 60 days
|July||No hospital or SNF stay|
|August||You’re admitted for a hospital stay August 5 (either for the same condition or a different one).
You’re released from the hospital and admitted to a skilled nursing facility August 23.
|N**||N||Fewer than 60 days have passed since your hospital stay in June, so you’re in the same benefit period.
· Continue paying Part A deductible (if you haven’t paid the entire amount)
· No coinsurance for first 60 days
· In the SNF, continue paying the Part A deductible until it’s fully paid.
· No coinsurance for the first 20 days in a skilled nursing facility*
|September||N**||Y||Pay a coinsurance amount starting on day 21 in the skilled nursing facility.|
|November||N**||Y||Pay all costs starting on day 101 in the skilled nursing facility (unless you have a Medicare Supplement plan – see details below.)|
|December||You’re released from the SNF December 2.||Y||If you still haven’t met the Part A deductible, you’ll continue paying for December 1 and 2.
Pay SNF costs for December 1 and 2.
*In this scenario, you’ve met the condition of having a “qualifying hospital stay” (3 days as an inpatient – more details below)
**You need to pay the Part A deductible until it’s all paid for this benefit period. How fast you meet your deductible amount depends on your Medicare-approved Part A costs for your services.
Please note that this is just an example. If you have multiple hospital stays and/or Skilled Nursing Facility stays within a year, you might want to contact Medicare to get details about your coverage. You can call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week.
What’s a qualifying hospital stay?
A qualifying hospital stay is a requirement you have to meet before Medicare covers your stay in a skilled nursing facility (SNF), in most cases. Generally, Medicare Part A may cover SNF care if you were a hospital inpatient for at least three days in a row before being moved to an SNF. Please note that just because you’re in a hospital doesn’t always mean you’re an inpatient – you need to be formally admitted. The day you’re discharged doesn’t count as an inpatient day.
How might a Medicare Supplement plan help with the costs of my hospital stay?
Medicare Supplement insurance is available from private insurance companies. In most states, there are up to 10 different Medicare Supplement plans, standardized with lettered names (Plan A through Plan N). All Medicare Supplement plans A-N may cover your hospital stay for an additional 365 days after your Medicare benefits are used up. (Massachusetts, Minnesota, and Wisconsin have different standardized plans.) Learn more about the different Medicare Supplement plans.
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