Key Takeaways

• Medicare provides substantial coverage, but you are still responsible for several out-of-pocket costs during a hospital visit.

• Understanding the structure of Medicare Parts A and B can help you prepare for deductibles, copayments, and limits on coverage.

Medicare and Hospital Visits: What You’re Actually Paying For

Many people assume that having Medicare means hospital visits are fully covered. This is not the case. While Medicare covers a significant portion of your healthcare expenses, it does not eliminate all costs. If you’re planning ahead for a potential hospitalization in 2025, it’s important to understand what Medicare will cover—and what you’ll need to pay out of pocket.

Hospital care under Medicare is mostly covered under Part A, but this part has its own rules, deductibles, and limits. Additional services and treatments may fall under Part B or even require separate arrangements.

What Medicare Part A Covers During a Hospital Stay

Medicare Part A typically covers:

• Semi-private room

• Meals during the stay

• General nursing

• Drugs administered as part of inpatient treatment

• Hospital services and supplies

But this coverage isn’t unlimited. For each benefit period in 2025, you are responsible for:

• An inpatient hospital deductible of $1,676 per benefit period

• Daily coinsurance after 60 days of inpatient care ($419 per day from days 61–90)

• Higher coinsurance for lifetime reserve days beyond 90 days ($838 per day)

A benefit period begins when you’re admitted and ends when you haven’t received hospital or skilled nursing care for 60 consecutive days. You could face multiple benefit periods in one year.

What Happens When You Need Extended Hospital Care?

Hospital stays beyond 60 days become increasingly costly. Medicare allows up to 90 days of inpatient coverage per benefit period, plus 60 lifetime reserve days. After that, you are responsible for all costs.

This means:

• If you’re hospitalized for more than 90 days during a benefit period, you must start using your lifetime reserve days.

• Once your lifetime reserve days are exhausted, Medicare Part A no longer pays for the hospital stay.

In these cases, the entire cost of each additional day falls on you. Planning for such extended hospitalizations can be financially crucial, especially if you have chronic conditions.

Medicare Part B and Outpatient Costs

Hospital care isn’t always strictly inpatient. Many procedures, even when done in a hospital setting, fall under outpatient care—which Medicare Part B covers.

In 2025, Medicare Part B includes:

• A standard monthly premium of $185

• An annual deductible of $257

• Coinsurance of 20% for most services once the deductible is met

This includes services such as:

• Emergency room visits not resulting in inpatient admission

• Diagnostic tests

• Observation stays

• Physician fees while you are hospitalized

So, while your hospital bed and meals may be under Part A, the doctor who sees you during that stay might bill under Part B. It’s common for Medicare enrollees to face unexpected Part B bills after what felt like a fully covered hospital visit.

Observation vs. Inpatient Status: Why It Matters

One of the more confusing issues under Medicare is the difference between inpatient admission and observation status. Even if you’re in a hospital bed overnight, you might still be considered an outpatient.

Observation status means:

• Your stay is covered under Part B, not Part A

• You pay a 20% coinsurance after meeting the deductible

• Hospital services such as X-rays and lab tests are billed separately

This matters most if you need post-hospital care in a skilled nursing facility. Medicare Part A only covers that if you’ve had a three-day inpatient stay—not observation.

Understanding the Cost of Skilled Nursing Facilities

If you do qualify for a skilled nursing facility stay after hospitalization, Medicare Part A covers it, but again, not indefinitely.

Here’s how it works in 2025:

• Days 1–20: Fully covered by Medicare

• Days 21–100: $209.50 daily coinsurance

• After day 100: You pay all costs

That 100-day limit is per benefit period. If you require multiple stays throughout the year without a 60-day break, your cost exposure increases significantly.

Additional Services You May Need to Pay For

Even during a hospital stay, there are services that Medicare does not fully cover—or doesn’t cover at all. These may include:

• Private-duty nursing

• Television and phone services (if charged separately)

• Personal care items like razors or socks

Medicare also doesn’t cover:

• Long-term custodial care

• Most dental services

• Hearing aids

• Routine eye exams

If these services are necessary during your hospital stay, you may be billed separately or need to make alternative arrangements for payment.

Your Annual Out-of-Pocket Costs Add Up

Though Medicare does reduce your hospital costs significantly, those remaining out-of-pocket charges can still pile up:

• A hospital deductible of $1,676 for each benefit period

• Daily coinsurance for long stays

• Part B deductible and 20% coinsurance

• Skilled nursing facility coinsurance past day 20

• Services not covered at all

Over the course of a year, this could mean paying several thousand dollars out of pocket depending on your health condition and number of hospital visits.

Emergency Room Visits Aren’t Always Fully Covered

Emergency room services typically fall under Part B unless you’re admitted to the hospital. This means:

• You’re responsible for 20% of the cost

• Services like imaging, lab tests, and doctor fees also fall under Part B

• If you’re not admitted, your hospital stay isn’t considered inpatient

Even a few hours in the ER could result in significant bills if you aren’t admitted for further treatment.

Hospital Readmissions and Multiple Deductibles

Every new benefit period restarts the Part A deductible. If you’re readmitted after 60 days, you’ll owe another $1,676 deductible. This can happen multiple times in one year.

Some patients are surprised by how quickly their medical costs stack up, especially if they require hospital care more than once within a calendar year.

How to Prepare for These Costs

You can take several steps to prepare yourself financially for the potential costs Medicare doesn’t cover:

• Set aside funds for medical emergencies

• Review supplemental coverage options carefully (without relying solely on them)

• Understand your benefit periods and track them throughout the year

• Talk to a licensed agent to fully explore your options

Educating yourself is the first step to minimizing financial surprises. Knowing what you’ll owe under Medicare lets you plan better.

When You Need Help Understanding Your Medicare Costs

Hospital visits are rarely predictable, and Medicare’s structure can be confusing. But understanding what you’re responsible for can help prevent shock when the bills arrive. Whether it’s a short ER visit or a prolonged hospital stay, Medicare has gaps—and those gaps can be expensive.

If you’re unsure how this applies to your situation or need help planning ahead, speak with a licensed agent listed on this website for professional advice and guidance.