When you think about Medicare, what comes to mind?
Doctor’s visits? Prescriptions? Medical tests?
But probably not hospital care. And that can be a problem. Because hospital stays can cost thousands of dollars.
According to the Healthcare and Cost Utilization Project, the average total cost for a hospital stay by a Medicare patient is $13,600.
How much of that will you have to pay out of your own pocket? That depends on your hospitalization coverage…which means Medicare part A.
So, let’s look at how Medicare part A coverage works, and what might be different if you have a Medicare Advantage plan.
What is Medicare Part A and How Do You Qualify?
Part A is the part of traditional Medicare that covers hospitalization-related expenses.
Like part B, you sign up through Social Security. This happens automatically if you already receive Social Security. If you don’t (yet), you can sign up for part A and part B at your Social Security office or via the website (https://www.ssa.gov).
Medicare part A covers inpatient hospital stays (semi-private room) including meals and nursing care, plus stays in a skilled nursing facility after your hospital stay. It also covers hospice care for the terminally ill.
You qualify for part A coverage if:
- You’re a U.S. citizen or legal resident for at least five years
- You’re 65 or older, or
- You have received Social Security Disability Insurance for 24 months, or
- You have End Stage Renal Disease (ESRD) or ALS (commonly known as Lou Gehrig’s disease)
What Does It Cost?
There’s no monthly premium for Medicare part A…that is, if you or your spouse worked (and paid Medicare taxes) for at least ten years.
Otherwise, you’ll pay a premium based on how long you (or your spouse) worked.
For 2025, the monthly premium if you worked less than 39 quarters is $518. If you worked for 30-39 quarters, the premium drops to $285/month.
But even if you (like most people) qualify for free Medicare part A, you’ll have additional costs.
For hospital stays:
- Deductible: $1,676 deductible per benefit period
- For days 1-60: zero copay after the deductible
- Days 61-90: $419 per day
- Over 90 days: $838 per day
(using lifetime reserve days – you can only these once in your lifetime!)
After 90 days in the hospital, you pay 100% of hospital costs unless you use lifetime reserve days.
For stays at a skilled nursing facility:
- Days 1-20: No daily copay
- Days 21-100: $209.50 per day
- You pay all costs after 100 days
A Medicare Supplement policy can help cover these extra charges, but each policy can have different coverage limits.
What If You Have Medicare Advantage?
Medicare Advantage (a.k.a. Medicare part C) policies cover the same things as traditional Medicare (parts A and B). They may also provide additional coverage like prescription, dental, and other benefits.
Some Medicare Advantage policies don’t charge an additional premium above what you pay for Medicare part B. This can save you money compared to the cost of a Medicare Supplement policy plus prescription (part D) coverage.
However, Medicare Advantage plans can also have limitations (including hospital coverage) not found in traditional Medicare and Medicare Supplement.
These can include:
- Higher deductibles and copayments
- Limited provider networks for hospitals and other facilities
- Limited coverage areas
What This Means For You
Hospital stays…even short ones…can be scary. They can also be expensive. Definitely not the best time to try to learn what Medicare will (or won’t) cover.
As a Medicare advisor, I have helped hundreds of clients understand their coverage and also acted as their advocate when unexpected hospital stays happen.
Feel free to reach out to me if you have questions. I’m here to take the mystery out and put the “care” back into your Medicare coverage.
I’m always available at scott.goodell@ghstx.com or via my contact form.
Scott Goodell
Goodell Health Services
Disclaimer:
The information provided by Goodell Health Solutions is for general informational purposes only and should not be considered legal, financial, or medical advice. We are licensed Medicare insurance agents, and our role is to help you understand your Medicare options.