Medicare Hospital Stay Limits: What's Covered?

Medicare Part A covers inpatient hospital stays, but patients are responsible for paying a portion of the costs. There is a deductible of $1,676 per benefit period, and patients owe $0 coinsurance for days 1-60 of hospitalization. For days 61-90, patients owe $419 per day in 2025, and for days 91 and after, patients owe $838 per day for each of their 60 lifetime reserve days. After the 60 reserve days are used, there is no coverage, and patients owe the full cost. Medicare Advantage plans also vary in their level of coverage, with some plans having a daily copay that starts immediately.

Inpatient hospital stays

Medicare Part A provides coverage for inpatient hospital care, including surgeries, bloodwork, and other diagnostics. It also covers hospice care and limited skilled nursing facility and home health services. While Medicare Part A covers inpatient hospital stays, patients are responsible for paying a portion of the costs, including a deductible and daily copayments. The deductible for 2025 is $1,676 per benefit period, and there are no costs for the first 60 days of basic hospitalization. For days 61-90 of hospitalization, patients owe a coinsurance of $419 per day in 2025 for each benefit period.

After 90 days, patients can use up to 60 lifetime reserve days, which are extra days of Medicare coverage for long hospital stays. These days come at a higher cost, with a coinsurance of $838 per day in 2025. Lifetime reserve days can be used only once, but they don't have to be used all in one hospital visit. For example, if a patient has two extended hospital stays, each amounting to 120 days, they can use 30 lifetime reserve days for each period.

Medicare Advantage plans, also known as Part C, may have a daily copay that starts immediately for the first few days or the first week in the hospital. These daily costs can add up to more than the Part A deductible, depending on the specific plan and length of stay. Medicare Advantage plans vary in their level of coverage, and benefits are significantly reduced if the hospital or medical provider is out-of-network.

In terms of inpatient hospital stays, Medicare Part A covers up to 90 days of inpatient hospital care each benefit period. The benefit period begins the day the patient is admitted and ends after they have been out of the hospital for 60 consecutive days. If the patient is admitted after this 60-day period, a new benefit period starts, and they must pay the deductible again.

Medicare also covers inpatient psychiatric facilities, providing up to 190 days of inpatient mental health care in a freestanding psychiatric hospital during a person's lifetime. However, this 190-day limit does not apply to care received in a Medicare-certified psychiatric unit within an acute care or critical access hospital.

In summary, Medicare Part A covers inpatient hospital stays, but patients are responsible for a portion of the costs, including a deductible and coinsurance payments. There are also limits to the number of days covered, with 90 days covered in each benefit period and an additional 60 lifetime reserve days available at a higher cost. Medicare Advantage plans may have different cost structures, with daily copays and varying levels of coverage depending on the plan and provider network.

Lifetime reserve days

Medicare Part A covers up to 90 days of inpatient hospital care during each benefit period. If your hospital stay exceeds 90 days, you can use your 60 lifetime reserve days. These reserve days are additional days that Medicare Part A will pay for, and they can be used only once in your lifetime.

If you're still hospitalized after 90 days, you can choose to use your lifetime reserve days, or pay out of pocket. For each of the 60 lifetime reserve days, you will owe a copay of $838 per day in 2025, and Medicare will cover the rest of the hospital costs. If you choose to pay out of pocket, you will need to notify the hospital that you do not want to use your lifetime reserve days, either while still in the hospital or up to 90 days after leaving. However, you will be required to pay the full cost of your care for those days.

It is important to note that your 60 lifetime reserve days do not renew if you start a new benefit period. This set of extra days can only be used once in your lifetime. If you are discharged from the hospital after a total of 100 days, you will have used up 10 of your lifetime reserve days, leaving you with 50 remaining days for future hospitalizations.

Medicare Advantage plans have built-in caps on out-of-pocket costs, which can provide an alternative to using your lifetime reserve days. These plans cover services at in-network hospitals and facilities, and the out-of-pocket costs cannot exceed a certain limit. However, it is important to understand the specifics of your plan and any prior authorization requirements.

Additionally, if you buy a Medigap policy, it can help pay your hospital coinsurance costs and provide up to 365 additional days of inpatient coverage after your Medicare lifetime reserve days are used up.

Out-of-pocket costs

For Medicare Part A, most people don't pay a premium if they have worked for 10+ years and had Social Security taxes withheld. However, if you don't qualify for premium-free Part A, you may pay up to $518 monthly in premiums. In 2025, there is also a deductible of $1,676 per benefit period that you must pay before coverage kicks in. After meeting the deductible, you will pay a portion of your daily costs based on the length of your stay. Each benefit period covers up to 90 days of inpatient hospital care, and you have an additional 60 lifetime reserve days that can be used once. You will pay a coinsurance of $838 per day for these reserve days.

Medicare Part B has a monthly premium that starts at $185 and increases with your income level. There is also an annual deductible of $257. After meeting the deductible, you will pay 20% coinsurance of the Medicare-approved amount for most of your medical costs.

Medicare Advantage (Part C) plans may offer lower out-of-pocket expenses, such as daily hospital copayments. However, these plans vary in their level of coverage, and some only cover services at in-network hospitals and facilities. Supplemental coverage options like Medigap policies or Medicare Supplement Insurance can help offset out-of-pocket costs, but there is no yearly limit on what you pay out-of-pocket unless you have one of these supplemental plans or a Medicare Advantage Plan.

Medicare Advantage plans

When it comes to hospital stays, Medicare Advantage plans must disclose the standard charges for their services, including those negotiated with Medicare. This information is made public to help individuals make informed decisions about their healthcare. Medicare Advantage plans cover inpatient hospital services, but the specifics of coverage depend on the particular plan chosen.

In terms of length of stay, Medicare Advantage plans, like Original Medicare, typically cover up to 90 days of inpatient hospital care per benefit period. If an individual requires a longer stay, they can utilise their 60 lifetime reserve days, which provide additional coverage. However, coinsurance costs apply for these reserve days, and individuals may need to pay a daily coinsurance out of pocket.

It's worth noting that Medicare Advantage plans do not cover long-term stays at skilled nursing facilities. However, if an individual is transferred from such a facility to an acute care hospital, their Medicare coverage may resume. Additionally, Medicare Advantage plans do not cover outpatient treatment provided by doctors at acute care hospitals.

Psychiatric hospital stays

Medicare is the national health insurance programme available to all Social Security recipients over 65 or permanently disabled. It also covers individuals receiving railroad retirement benefits and those living with end-stage renal disease.

Medicare Part A covers inpatient mental health services in psychiatric hospitals (which only treat mental health patients) and general hospitals. If you receive care in a psychiatric hospital, Medicare Part A will only cover up to 190 days of inpatient psychiatric services during your lifetime. This limit does not apply to psychiatric units within general hospitals or any other Medicare specialty inpatient hospital service.

The 190-day limit has been criticised as discriminatory, creating barriers and disruptions to care for people with serious mental illnesses, who may require ongoing treatment and multiple hospitalisations over their lifetime. These conditions may include schizophrenia, bipolar disorder, or major depressive disorder.

If you have reached your 190-day limit but still require mental health care, Medicare may cover your treatment at a general hospital. You will have the same out-of-pocket expenses whether you are treated in a general or psychiatric hospital. After meeting your Part A deductible, Original Medicare pays in full for the first 60 days of your benefit period. From day 61 to 90, there is a daily co-pay, followed by 60 "lifetime reserve days" at a higher daily co-pay. After that, nothing is covered for the stay.

Medicare Part B covers services received from other providers while in the hospital, typically covering 80% of the Medicare-approved amount. It also covers intensive outpatient program services received at a hospital, community mental health centre, Federally Qualified Health Centre, or Rural Health Clinic.

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