Hospital Coverage Under Medicare Part A
When you receive Medicare through SSDI, Part A is the hospital insurance that covers your inpatient stays. Part A pays for a hospital bed, meals, nursing care, medications given in the hospital, and basic medical equipment like wheelchairs or oxygen tanks while you're admitted. It does not cover the doctor's fees separately—those come under Part B—but the hospital facility itself is covered.
Part A covers up to 60 days in a single benefit period with no copay for the first three days. Starting on day four, you pay a copay amount that changes each year. After 60 days, your coverage continues but the copay increases. If you stay longer than 90 days, you enter what Medicare calls "lifetime reserve days"—a pool of 60 additional days you can use once in your lifetime, each with a higher copay.
A benefit period begins the day you enter the hospital and ends 60 days after you leave. If you go home and then return to the hospital more than 60 days later, a new benefit period starts and your copay resets to zero for the first three days.
Key Takeaways
- Medicare Part A covers the hospital facility, bed, meals, and nursing care during an inpatient stay, but you pay a copay starting on day four.
- Doctor visits, tests, and surgeries performed in the hospital are covered under Part B, which has its own copay and deductible.
- Skilled nursing facility care after hospitalization is covered by Part A for up to 100 days if you meet the requirements, but only after a may have access to three-day hospital stay.
- Emergency room visits are covered by Part B whether or not you are admitted, but you pay a copay at the time of service.
- Outpatient hospital services like imaging, lab work, or same-day surgery are covered by Part B, not Part A.
What Part B Covers During a Hospital Stay
Part B is medical insurance and it covers the doctors, specialists, and diagnostic services you receive while in the hospital. If a cardiologist sees you, if you have blood work done, if you receive an EKG or CT scan, or if you have surgery—Part B pays its share of those costs. You pay a copay or coinsurance for each service, and you must have met your Part B deductible for the year.
Part B copays and coinsurance vary by service type. A doctor visit might be 20 percent coinsurance after your deductible, while an outpatient test might be a flat copay. If multiple doctors see you during your hospital stay, you pay for each one separately.
One important distinction: if you are admitted to the hospital as an inpatient under Part A, the doctors' services are still billed to Part B. You are not paying twice, but you are responsible for Part B's cost-sharing on top of Part A's copay for the bed.
Skilled Nursing Facility Care After Hospital Discharge
If your hospital stay qualifies you for skilled nursing facility (SNF) care, Part A covers up to 100 days in a single benefit period. You must have been admitted to the hospital as an inpatient for at least three consecutive days (not counting the day you leave) to be may be able to access. The facility must be Medicare-approved and your doctor must order the care as medically necessary.
Part A covers the first 20 days with no copay. From day 21 through day 100, you pay a copay per day. After 100 days, you pay all costs out of pocket. SNF care includes a bed, meals, nursing, therapy, and medical equipment—similar to hospital coverage but in a different setting.
Not all nursing homes are SNFs, and not all stays in an SNF are covered. The facility must provide skilled care—meaning nursing or therapy that requires a trained professional—not just help with daily activities. If you need only custodial care, Part A does not cover it.
Emergency Room and Urgent Care Coverage
Emergency room visits are covered by Part B whether you are admitted to the hospital or sent home. You pay a copay at the time of service, usually between $150 and $300 depending on your plan, and this copay is waived if you are admitted as an inpatient. Urgent care centers that are not hospital-based are also covered by Part B with a copay.
Part B covers the emergency room facility, the doctor's evaluation, X-rays, blood work, and other diagnostic services. If you need surgery or admission during an ER visit, Part A takes over for the inpatient portion and your Part B copay is waived.
Outpatient Hospital Services and Same-Day Procedures
Hospital outpatient services—imaging, lab work, physical therapy, or same-day surgery—are covered by Part B, not Part A. You pay a copay or coinsurance for each service after meeting your Part B deductible. The hospital facility charge is separate from the doctor's charge, so you may receive two bills.
Outpatient surgery at a hospital is covered by Part B. You pay your copay or coinsurance for the facility and separately for the surgeon and anesthesiologist. If the procedure requires an overnight stay, it becomes an inpatient admission and Part A takes over.
What Medicare Does Not Cover in the Hospital
Medicare Part A and Part B do not cover private duty nursing, a private room (unless medically necessary), television, telephone, or personal comfort items. They do not cover experimental treatments or procedures deemed not medically necessary. Cosmetic procedures are not covered unless they are reconstructive and follow an injury or illness.
If you receive care from an out-of-network provider or travel outside the United States, coverage is limited or absent. Original Medicare (Part A and Part B) has no out-of-network concept within the U.S., but some providers may not accept Medicare assignment, meaning you could owe more.
Prescription drugs you take at home are not covered by Part A or Part B. You need Part D prescription drug coverage for that. Some hospitals provide medications during your stay, which Part A covers, but once you leave, Part D takes over.
Medigap and Medicare Advantage: How They Change Hospital Coverage
If you have a Medigap policy (supplemental insurance), it pays some or all of the copays and coinsurance that Part A and Part B leave you responsible for. Different Medigap plans cover different amounts, but most cover the Part A copay after day three and some cover the Part B deductible. Medigap does not expand what Medicare covers—it only reduces what you pay out of pocket.
If you have Medicare Advantage instead of Original Medicare, your hospital coverage works differently. Advantage plans must cover everything Part A and Part B cover, but they may have different copays, deductibles, and network requirements. Some Advantage plans cover services that Original Medicare does not, like dental or vision, but you must use in-network providers or pay more.
Frequently Asked Questions
Do I pay anything for the first three days in the hospital?
No. Part A covers the first three days with no copay. Starting on day four, you pay a copay amount per day. However, you still pay Part B copays for doctors and services during those first three days.
What happens if I need to stay in the hospital longer than 90 days?
After 90 days, you can use your lifetime reserve days—60 additional days available once in your lifetime. Each reserve day has a higher copay than regular hospital days. After you exhaust your reserve days, you pay all hospital costs out of pocket.
If I go to the ER but don't get admitted, do I still have to pay?
Yes. Part B covers the ER visit and you pay a copay, usually $150 to $300. If you are then admitted to the hospital, that copay is waived and Part A coverage begins.
Does Medicare cover the cost of an ambulance to the hospital?
Part B covers medically necessary ambulance transport to a hospital or skilled nursing facility. You pay 20 percent coinsurance after your Part B deductible. Non-emergency transport is usually not covered.
What if my doctor says I need to stay in the hospital but Medicare says it's not necessary?
You have the right to appeal Medicare's decision. The hospital must give you a written notice explaining why Medicare denied coverage. You can request an expedited review, and if you disagree with the outcome, you can file a formal appeal with Medicare.