Think Medicare Covers Everything in the Hospital? Let’s Clear That Up Right Now

Key Takeaways

• Medicare does not cover every cost associated with hospital stays, and knowing your share of the costs is essential to avoid unexpected bills.

• Understanding the roles of Part A, Part B, and other options helps you plan effectively for inpatient and outpatient care in 2025.

What Medicare Part A Really Covers During a Hospital Stay

Medicare Part A is often referred to as hospital insurance, but it’s important to understand its exact scope. In 2025, Part A helps cover:

• Inpatient hospital stays (after a formal inpatient admission)

• Skilled nursing facility (SNF) care after a qualifying hospital stay

• Hospice care for terminal illnesses

• Limited home health care services

However, Part A is not limitless. It comes with cost-sharing, specific rules, and exclusions that may leave you paying more out-of-pocket than expected.

Coverage Periods and Benefit Period Limits

Medicare Part A uses benefit periods. A benefit period begins the day you are admitted as an inpatient and ends when you haven’t received inpatient care for 60 consecutive days.

For each benefit period in 2025:

• You pay a $1,676 deductible before coverage begins.

• Days 1–60: You pay $0 per day (after deductible).

• Days 61–90: You pay $419 per day.

• Days 91–150: You pay $838 per day (using your 60 lifetime reserve days).

• After day 150: You pay all costs.

That means if you’re hospitalized multiple times in the year with breaks longer than 60 days, you could face multiple deductibles.

What Part A Doesn’t Cover Inside the Hospital

While Part A does handle many inpatient services, there are several things it doesn’t pay for, even during a hospital stay:

• Doctor services during the stay (covered under Part B)

• Private-duty nursing

• Personal items like television, phone, or toiletries

• A private room (unless medically necessary)

Additionally, medications you receive as an inpatient are typically covered, but only while you’re officially admitted as an inpatient—not during observation status.

Observation Status: A Costly Gray Area

One of the most misunderstood areas is the difference between inpatient admission and observation status.

Even if you’re in a hospital bed overnight, you might be classified as “under observation.” In this case:

• Part B, not Part A, covers your stay.

• You could pay more in outpatient coinsurance.

• It may affect your eligibility for skilled nursing facility care, which requires a three-day inpatient stay.

This distinction can make a significant difference in what Medicare pays and what you owe. Always ask your care team how you are classified.

Skilled Nursing Facility: Not Automatically Covered After Hospital Discharge

You may assume that if you need rehabilitation or skilled nursing after a hospital stay, Medicare will step in. That’s only partly true.

To qualify for Medicare Part A coverage of a skilled nursing facility (SNF):

• You must have a qualifying inpatient hospital stay of at least three consecutive days (not counting discharge day).

• You must need skilled care related to the condition treated during your hospital stay.

Even with this, coverage is limited:

• Days 1–20: You pay $0 per day.

• Days 21–100: You pay $209.50 per day.

• After 100 days: You pay all costs.

SNF stays can become costly quickly if you’re not aware of these limitations.

Medicare Part B and Its Role in Hospital Settings

Part B, which is considered medical insurance, also plays a role while you’re in the hospital—especially when it comes to services from doctors and specialists.

Part B covers:

• Physician visits during an inpatient stay

• Outpatient services (like lab tests or imaging)

• Emergency room visits before inpatient admission

• Observation services

In 2025, the standard Part B premium is $185 per month, and the deductible is $257. After meeting the deductible, you generally pay 20% of the Medicare-approved amount for most services.

Understanding how Part A and Part B interact during a hospital experience is key to preparing for total costs.

Outpatient Hospital Services: Frequently Overlooked Costs

Outpatient services performed at hospitals, such as same-day surgeries or diagnostic testing, are covered under Part B. These are common scenarios:

• You receive a diagnostic test and are sent home the same day.

• You have a same-day surgery in a hospital outpatient setting.

• You undergo physical therapy or chemotherapy on an outpatient basis.

For all of these, you are responsible for:

• The Part B deductible ($257)

• 20% of the Medicare-approved amount

These expenses can add up quickly, especially for high-volume services like imaging or infusions.

What About Hospital Drugs? That Depends

Prescription drugs given during hospital stays are covered differently based on your status:

• Inpatient drugs: Covered under Part A (bundled into hospital stay cost)

• Outpatient drugs: May be billed under Part B or not covered at all

If you’re under observation or receiving outpatient care, you may have to pay out of pocket for certain medications, especially if they’re considered self-administered.

You may need separate drug coverage to help manage these gaps.

Emergency Room Visits: Coverage Varies by Outcome

Medicare handles ER visits based on what happens after the visit:

• If you’re treated and released, Part B covers the ER visit as an outpatient service.

• If you’re admitted as an inpatient, Part A covers the ER services as part of the hospitalization.

In both cases, you’re still responsible for copayments, the Part B deductible, and any additional outpatient coinsurance.

What to Know About Hospital Readmissions

If you’re readmitted to the hospital within a short time frame, you may face:

• A new benefit period (if 60 days have passed since discharge)

• A second Part A deductible

• Another round of coinsurance charges

Hospital readmissions can be financially draining, even within the same calendar year, depending on timing.

Coverage Gaps You May Want to Prepare For

Despite how much Medicare helps, there are several potential gaps that may catch you off guard:

• You could pay more if you’re under observation instead of inpatient.

• You might not qualify for SNF care if your hospital stay doesn’t meet the three-day rule.

• You may be billed for hospital medications not fully covered under Part A or B.

• Multiple hospitalizations within a year could trigger multiple deductibles.

Medicare provides a strong foundation, but it doesn’t eliminate all costs.

How to Plan Ahead for Unexpected Hospital Costs

To prepare for hospital care under Medicare in 2025, consider the following steps:

• Review your Medicare Summary Notice (MSN) regularly.

• Understand your benefit periods and track hospital days.

• Ask your hospital or doctor about inpatient vs. observation status.

• Learn which services fall under Part A vs. Part B.

• Consider additional coverage to help with out-of-pocket expenses, if eligible.

Proactive planning can reduce financial stress during emergencies or extended hospital stays.

Don’t Assume—Get the Full Picture Before Your Next Hospital Visit

Hospital care under Medicare in 2025 is more nuanced than many people realize. While Part A gives you a base level of coverage, there are rules, timelines, and gaps you can’t afford to ignore.

By staying informed, asking questions, and reviewing your Medicare benefits closely, you can avoid unexpected costs that might otherwise catch you off guard.

If you’re unsure how your Medicare coverage applies to a specific hospital situation, talk to a licensed agent listed on this website for personalized guidance.