If you get sick or injured and need hospital care, which can cost thousands of dollars, would you be able to afford it? Research published in the Annals of Internal Medicine suggests it may be a challenge for many seniors on Medicare.
The study, conducted at the University of Pennsylvania, found that 45% of Medicare beneficiaries with modest incomes may not have sufficient funds to cover the more than $1,700 deductible and any additional out-of-pocket costs incurred during a hospital stay.
To make sure you’re covered in the event you need to be hospitalized, it’s helpful to know how much Medicare pays for a hospital stay and how much you’ll have to contribute to hospital care if you need it.
[READ: How to Advocate for an Older Loved One in the ER or Hospital]
Does Medicare Cover 100% of Hospital Bills?
No, Medicare does not cover 100% of your costs for a hospital stay. Your expenses depend on how long you’re hospitalized and what kind of Medicare coverage you have, says Whitney Stidom, vice president of consumer enablement with eHealth Inc., a health insurance broker and online resource provider headquartered in Austin.
Medicare is a federal government health insurance program designed for people age 65 and older and some younger individuals with qualifying disabilities. It’s broken into several parts, with Medicare Part A covering inpatient hospital care.
Medicare Part A covers up to 150 days in the hospital per benefit period, after you’ve paid the Medicare Part A deductible, Stidom explains. A benefit period stretches from the day you’re admitted to the hospital until you’ve been out of the hospital for 60 consecutive days.
Most people do not have to pay a premium for Medicare Part A because they or their spouse paid Medicare payroll taxes while working long enough to qualify for premium-free Part A, explains Dr. Billy Zhang, an internal medicine physician specializing in aging adults with Providence St. Joseph Hospital in Orange County, California.
However, he notes, even when the premium is $0, Part A is not ‘free’ at the point of care — even for covered services. “You are responsible for a deductible for each benefit period when you are admitted to the hospital.”
Your out-of-pocket costs for inpatient hospital care depend on the duration of your stay. For example, once your stay has exceeded 60 days, you’ll begin paying an additional daily coinsurance fee. This fee increases again after 90 days of hospitalization. Once you hit 151 days, you’ll be responsible for 100% of the costs of care.
It’s also worth noting that while “Part A covers necessary treatment delivered during the hospitalization, it may not cover care after you are discharged from the hospital,” Zhang says.
Hospital costs under Medicare Part A
| Duration of Stay | What Medicare Pays | What You Pay |
| Day 1-60 | 100% of costs after deductible is met | $0 after you’ve met the deductible ($1,736 in 2026) |
| Day 61-90 | Any costs beyond $434 per day | $434 per day in 2026 |
| Days 91-150 | Any costs beyond $868 per day | $868 per day in 2026; these days are known as “lifetime reserve days,” and you have up to to use |
| Days 151 and beyond | Nothing | You pay 100% of the costs |
These rules apply for any given Medicare benefit period, Stidom adds.
If you’re readmitted to the hospital later in the same year, you’ll have to pay the hospital deductible again.
How Much Does Medicare Advantage Pay for a Hospital Stay?
Medicare Advantage coverage costs vary widely from state to state and from plan to plan, so what your plan will pay for a hospital stay may differ from other plans.
Medicare Advantage is offered by private health insurance companies in coordination with Medicare, and by law, these plans must offer the same coverage as original Medicare at minimum. Medicare Advantage plans, for instance, cover hospital care and outpatient services.
However, there are some overall variations in the Medicare Advantage cost structure:
— Premiums: Many plans offer a $0 monthly premium, though you’ll still need to pay the Medicare Part B premium ($202.90 in 2026).
— Safety net: Medicare Advantage plans offer a maximum out-of-pocket limit ($9,250 in 2026) that original Medicare does not.
— Trade-offs: Medicare Advantage plans typically have smaller provider networks and may also require prior authorizations for many services. For some seniors, these restrictions and limitations may not justify the cost savings.
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Which Parts of a Hospital Stay Does Medicare Cover and What’s Excluded?
In a hospital setting, Medicare Part A covers several broad areas of care and services:
— General hospital services and supplies
— General nursing care
— Meals
— Drugs administered while you’re admitted
— Semi-private room charges
Medicare Part A also covers up to 100 days of skilled nursing care after you’ve been discharged from the hospital, Stidom says.
However, there are some aspects of care that Medicare will not cover:
— A private hospital room (unless it’s medically necessary)
— Private nursing
— Personal care items, such as toiletries
— Routine dental, vision or hearing care
Medicare Supplement Plans (Medigap) May Help Reduce Costs
People who have original Medicare may be able to purchase a Medicare supplement policy, also called a Medigap plan, that helps cover costs original Medicare does not. For instance, a Medigap plan may cover your Part A deductible and other out-of-pocket costs you’ll incur if you seek hospital care.
Medigap plans also typically cover the 20% of costs that patients are responsible for paying when accessing Part B benefits.
You cannot pair a Medigap plan with a Medicare Advantage plan, which already has a maximum out-of-pocket limit.
Types of Facilities Where Medicare Pays for Care
There are several types of facilities where your Medicare Part A coverage will apply:
| Facility Type | What It Is | Who It’s For | What Medicare Part A Covers |
| General acute care hospitals | Conventional hospital for sick or injured individuals who need constant medical supervision | Seriously ill or injured individuals needing inpatient hospital care | 100% of inpatient costs covered for first 60 days of a benefit period after deductible ($1,736 in 2026) is met; reduced benefits for subsequent days |
| Inpatient rehab facilities | Inpatient facilities providing intensive rehabilitative services including physical, occupational and speech therapy, as well as care and services to help restore mobility and function after an illness, injury or surgical procedure | Patients who no longer need constant medical supervision but are not healthy enough to return home | 100% covered if care is medically necessary and if patient shows continued improvement for first 60 days of benefit period after deductible ($1,736 in 2026) is met; reduced benefits for subsequent days |
| Psychiatric hospitals | Hospitals that provide inpatient mental health treatment | Patients with severe mental health issues that require inpatient care and supervision | 100% covered for 60 days of benefit period after deductible ($1,736 in 2026) is met; reduced benefits for subsequent days; Part A pays for 190 days of care in a freestanding psychiatric hospital during your lifetime |
| Long-term care hospitals | Similar to acute care hospitals but more focused on providing ongoing medical care for patients with long-term care needs | Designed to support individuals who need longer-term medical care | 100% covered for first 60 days of benefit period after deductible ($1,736 in 2026) is met; reduced benefits for subsequent days |
| Skilled nursing facilities | Also called nursing homes or SNFs, these facilities provide 24-hour nursing and custodial care | Aimed at individuals, typically older adults, who need ongoing nursing support and assistance with activities of daily living | 100% covered for first 20 days of benefit period after deductible ($1,736 in 2026) is met; reduced benefits for subsequent days |
Growth of the Hospital-at-Home Trend
Recently, Medicare has been expanding the range of home health services it covers. This “hospital-at-home” trend is aimed at people who need hospital-level care but can achieve similar results in the home setting with visiting nurses and doctors.
Receiving this type of care in the home can provide certain benefits including:
— A more comfortable environment for recovery
— Reduced demand on limited hospital beds
— Reduced exposure to pathogens in the hospital that could result in complications, infections or death
— Typically less expensive than inpatient care settings
Care received in the home has been found to be just as effective as in the hospital in many instances. To qualify, you must be assessed in person by a health care provider who certifies that you need home health services. These services must be provided by a Medicare-certified home health agency to qualify for coverage.
What Medicare covers at home
While not every condition is amenable to hospital-at-home care, Medicare covers services provided at home in some situations, including the following.
| Medicare-Covered Home Health Services | Examples of Care |
| Medically necessary part-time or intermittent skilled nursing care |
— — Wound care for pressure sores or a surgical wound — — Patient and caregiver education — — Intravenous or nutrition therapy — — Injections — — Monitoring serious illness and unstable health status — |
| Therapy services |
— — Physical therapy — — Occupational therapy — — Speech and language therapy — |
| Medical social services |
— — Counseling and mental health services — — Resource coordination — — Care and discharge planning — — Advocacy and connecting patients with community resources — |
| Part-time or intermittent home health aide care |
— — Limited to patients getting skilled nursing care and therapy services — — Help with walking — — Bathing or grooming — — Changing bed linens — — Feeding — |
| Supplies and medications |
— — Injectable osteoporosis medications for patients who meet certain criteria — — Durable medical equipment — — Medical support to be used at home — |
For these covered services, you’ll pay nothing. After you meet the Part B Deductible, you pay 20% of the Medicare-approved amount of Medicare-covered medical equipment if that’s part of your care plan. The agency should give you an Advance Beneficiary Notice of Non-coverage that outlines what’s covered and what’s excluded so you know what to expect before you begin getting services and supplies.
If you are a Medicare Advantage beneficiary, check your plan’s policy for more details about covered home health benefits.
What’s excluded from hospital-at-home coverage
While Medicare has expanded what services and supports it pays for in the home, it doesn’t cover everything. The following items are excluded from this coverage:
— 24-hour at-home care
— Home meal delivery
— Homemaker services, such as shopping and cleaning that’s unrelated to your care plan
— Personal care services and assistance with the activities of daily living, such as bathing, dressing or toileting if this is the only care you need
FAQ
What is the Medicare Part A deductible for 2026?
The Medicare Part A deductible for 2026 is $1,736.
What is the Medicare Part B premium for 2026?
The Medicare Part B deductible for 2026 is $283.
How many “Lifetime Reserve Days” does Medicare provide?
Original Medicare provides 60 lifetime reserve days.
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How Much Does Medicare Pay for a Hospital Stay? originally appeared on usnews.com
Update 02/27/26: This story was published at an earlier date and has been updated with new information.
