How Medicare Pays for Hospital Stays

Medicare Part A covers the cost of a hospital stay, but you pay part of it yourself through deductibles and copayments. The amount you pay depends on how long you stay and which type of hospital care you receive. Medicare pays the hospital directly for most of the bill, but you are responsible for specific out-of-pocket costs that reset each year on January 1st.

The payment structure is the same whether you are admitted for surgery, a heart attack, pneumonia, or any other condition that requires inpatient hospital care. What changes is how many days you stay and whether you move to a skilled nursing facility afterward.

Key Takeaways

  • You pay a single deductible per benefit period (usually one hospital stay or a series of related stays within 60 days), not per day.
  • Days 1 through 60 of a hospital stay require you to pay the deductible; Medicare covers the rest of the hospital bill.
  • Days 61 through 90 require a daily copayment; days 91 and beyond require a higher daily copayment and use your lifetime reserve days.
  • The deductible and copayment amounts change each year and are set by Medicare, not by your hospital or insurance plan.
  • If you are discharged to a skilled nursing facility, your hospital stay ends and a separate copayment structure begins.

The Deductible: What You Pay First

When you are admitted to the hospital, you owe a deductible before Medicare begins to pay. For 2024, that deductible is $1,632 per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave. If you are readmitted within 60 days, you do not pay a second deductible — you are still in the same benefit period.

Once you have paid the deductible, Medicare covers all covered hospital charges for days 1 through 60. You do not pay anything else during those first 60 days, no matter how much the hospital bill is. The hospital bills Medicare, Medicare pays the hospital, and you are done paying for that portion of your care.

If you have a second hospital stay more than 60 days after you left the first hospital, that starts a new benefit period and you owe a new deductible.

Days 61 Through 90: The Daily Copayment

If your hospital stay extends beyond 60 days, you begin to owe a daily copayment for each day you remain in the hospital. For 2024, that copayment is $408 per day. This applies to days 61, 62, 63, and so on, up to day 90 of your stay.

You pay this amount directly to the hospital or to Medicare, depending on how your bill is processed. The hospital cannot charge you more than this amount for these days — Medicare sets the price and pays the difference. If your stay reaches day 90, you stop owing the daily copayment and move into a different category.

Days 91 and Beyond: Lifetime Reserve Days

Medicare provides a limited number of lifetime reserve days for hospital stays that last longer than 90 days. You have 60 lifetime reserve days total, and you can use them only once in your lifetime. When you use a reserve day, you pay a higher daily copayment: for 2024, that is $816 per day.

Once you have used all 60 lifetime reserve days, Medicare stops paying for your hospital stay. You would then be responsible for the full cost of the hospital bill. This is rare — most hospital stays end well before day 90 — but it is important to understand if you face a very long hospitalization.

You cannot get more lifetime reserve days once they are exhausted. If you are concerned about a long stay, talk to your hospital social worker or case manager about what happens after your reserve days run out and what other payment options might be available.

What Is Included in Medicare's Hospital Payment

Medicare Part A covers the cost of a semi-private room (two beds), meals, nursing care, medications given during your stay, medical equipment and supplies used in the hospital, and lab tests and X-rays ordered by your doctor. It also covers surgery, anesthesia, and operating room costs.

Medicare does not cover private rooms unless medically necessary, television or telephone charges, personal care items like toiletries, or any care after you are discharged. Once you leave the hospital, Part A coverage ends and a different set of rules applies if you move to a skilled nursing facility or go home.

Skilled Nursing Facility Care After Hospital Discharge

If your doctor orders you to a skilled nursing facility (such as a nursing home for rehabilitation), Medicare Part A covers that care under different rules. You do not owe anything for days 1 through 20 of skilled nursing care, as long as you were hospitalized for at least three days first and admitted to the facility within 30 days of leaving the hospital.

For days 21 through 100 of skilled nursing care, you owe a daily copayment of $204 per day in 2024. After day 100, Medicare stops paying and you are responsible for the full cost. This is a separate benefit from your hospital stay — your hospital deductible and copayments do not count toward your skilled nursing facility costs.

How the Deductible and Copayment Amounts Change

Medicare announces new deductible and copayment amounts each October for the year ahead. The amounts usually increase slightly each year because hospital costs rise. The 2024 amounts listed in this article will change on January 1, 2025.

To find the current year's amounts, visit Medicare.gov or call 1-800-MEDICARE. Your hospital billing department can also tell you what you will owe based on the current year's figures. If you have a Medigap or Medicare Advantage plan, your plan may cover some or all of these out-of-pocket costs — check your plan documents or call your plan's customer service line.

Questions to Ask Your Doctor or Hospital

Before or during a hospital stay, ask your doctor and hospital billing department these questions: How many days do you expect my stay to last? Will I need to go to a skilled nursing facility after discharge? What is the total estimated cost of my hospital stay, and how much will Medicare pay? What will I owe out of pocket?

If you are facing a long stay or are worried about costs, ask to speak with a hospital social worker or financial counselor. They can explain your bill, discuss payment plans, and tell you about programs that might help if you cannot afford your out-of-pocket costs.

Frequently Asked Questions

Do I have to pay the deductible if I am admitted to the hospital as an emergency?

Yes. The deductible applies to all hospital admissions covered by Medicare Part A, whether you are admitted through the emergency room, scheduled in advance, or transferred from another facility. You cannot avoid the deductible by the way you enter the hospital.

What happens if I am in the hospital on January 1st when the new deductible takes effect?

The deductible that applies is the one in effect on the day you were admitted to the hospital. If you were admitted in December and are still there on January 1st, you pay the old year's deductible, not the new one. Your benefit period is based on your admission date, not the calendar year.

Can my hospital bill me more than the copayment amounts Medicare sets?

No. Hospitals that accept Medicare cannot charge you more than the deductible and copayment amounts set by Medicare. If a hospital tries to bill you for more, contact Medicare at 1-800-MEDICARE to report it.

If I have Medicare Advantage instead of Original Medicare, do these costs explore?

Medicare Advantage plans must cover the same hospital benefits as Original Medicare, but they may have different deductibles and copayments. Check your plan documents or call your plan to find out what you will owe for a hospital stay under your specific plan.

What if I cannot afford to pay my hospital copayments?

Talk to your hospital's financial counselor about payment plans or programs for people with low income. Some hospitals have charity care programs. You can also contact your state Medicaid office to see if you may have access to for help paying Medicare costs, or call the Eldercare Locator at 1-800-677-1116 to find local resources.