Medicare coverage if you go to the hospital
When it comes to Medicare, how much a patient pays in the event of a hospital stay really depends on what kind of coverage they have. Whether they have Original Medicare, a Medigap/Supplement plan, or a Medicare Advantage plan, how they are covered varies. Let’s review how hospital stay coverage works for each.
For someone who only has Original Medicare, which is Part A and Part B, Part A is going to be covering the stay in the hospital. There are costs and limitations with Part A coverage. The first cost associated with the hospital stay is a deductible that is applicable for any length of stay in the hospital and covers the first 60 days. The deductible for 2022 is $1,556. If a hospital stay extends beyond 60 days and up to 90 days, you would then be responsible for a $389 per day copay. Days 91-150 are referred to as “lifetime reserve days” meaning once you have used them, they are gone. The copay for these lifetime reserve days doubles to $778 per day. It is important to note that this coverage is only for the inpatient hospital services (room and board). Any doctor’s services received would be covered under Part B and would have separate costs.
Medicare supplements are going to work alongside Original Medicare as secondary insurance. After Medicare has paid their portion, the supplement plan will come in and pay the patients portion, but this will depend on the plan that the patient has. All Medicare supplement plans cover the hospital coinsurance costs up to an additional 365 days after Medicare benefits end. Some supplement plans cover the Part A deductible 100%, and others will only cover a certain percentage.
While Medicare Advantage plans must have at least the same coverage as Medicare, the costs associated with a hospital stay can vary by plan. These costs will typically be in the form of copays per day, but the dollar amount and the number of days being charged will most likely vary by plan and insurance company. You can refer to the summary of benefits for your plan, check with your plan, or one of our agents here at VibrantUSA to better understand the costs for a specific plan.
This is a simplified and basic explanation of how Medicare is going to cover you in the hospital. If you are trying to decide which of these options is best for you, or if you have questions about your current coverage, we are here to help. We look forward to answering your questions and helping you find the plan that meets your needs.