Hospital bills are a serious concern, so understanding your coverage is critical to your finances and overall health. We hope you avoid hospital stays, but if you do need inpatient care, it’s good to know what you’ll pay.
Let’s talk about the expected costs, savings and coverage you receive from Original Medicare (Parts A and B).
What does Medicare Part A cover?
Medicare Part A is hospital insurance. This will help cover medically necessary inpatient hospital care, including a semi-private room and meals, general nursing services, medically necessary medications, supplies and other hospital services that are part of inpatient treatment. Part A coverage also includes some blood transfusions and inpatient rehabilitation services.
What does Medicare Part B cover?
Medicare Part B is medical insurance. While you are in the hospital, this will help cover the cost of services from health care providers and doctors, preventive screenings and durable medical equipment.
Am I responsible for any costs related to inpatient hospital stays?
If you are hospitalized while on Original Medicare, you may be responsible for deductibles and coinsurance before Medicare begins to pay for the services listed above.
According to Medicare.gov, in 2023, your Part A deductible is $1,600. After that, Original Medicare pays in full for the first 60 days of your hospital stay. However, after the 60 days, you will pay a copayment each day:
- $400 per day for days 61 to 90
- $800 per day for anything after 91 days
- After day 150, you’ll pay all costs
In addition, since Medicare Part A does not cover a private room, personal care items or television or phone services, you may need to pay for these costs directly.
Medicare Part B also has a deductible and some additional fees, such as responsibility for 20% of the costs related to doctor and medical services.
Combined, the new cost schedule for a hospital stay for 2023 Medicare beneficiaries with Part A and Part B includes the following for each benefit period:
- Annual deductible of $1,600 for Part A
- $0 copay for days 1-60
- $400 copay per day for days 61-90
- $800 copay per each lifetime reserve day* (days 91+)
- Annual deductible for Part B
- 20% of the Medicare-approved amount for doctor and medical services covered by Part B
*”Lifetime reserve day” refers to extra days that Medicare will pay for all costs, except daily coinsurance, if you exceed the 90 days hospital stay. You get 60 lifetime reserve days over your lifetime.
Is there a limit to the costs I can incur on Original Medicare?
Original Medicare does not have a maximum out-of-pocket limit (MOOP). This means that if you are hospitalized several times during the year and/or have several medical expenses, you may end up paying a lot of money through
- Your Part A and Part B deductibles
- Any Part A coinsurance
- Your 20% Part B coinsurance
This is one of the biggest challenges for older adults on Original Medicare. There is no cap on how much you can incur from an inpatient hospital stay after the 91+ days. In addition, deductibles and coinsurance add up quickly and can be a financial burden.
Does having a Medicare Advantage or Medigap plan help reduce the cost of inpatient hospital stays?
In most cases, yes. All Medicare Advantage plans have a MOOP. The MOOP is the limit on annual out-of-pocket expenses that you’ll pay for medical services covered by your Medicare plan. Each year, the Centers for Medicare and Medicaid Services (CMS) sets a limit. A Medicare Advantage plan can’t set its limit higher than that amount, but it can set a limit that’s lower. Once your covered medical expenses meet your MOOP, the plan will pay 100% of your covered medical costs for the rest of the plan year.
Medigap insurance plans work alongside your Original Medicare coverage. This coverage is standardized, and these policies are labeled Plans A, B, C, D, F, G, K, L, M and N. Not all Medigap plans have a MOOP – only Medicare Supplement Plans K and L include annual out-of-pocket limits. These limits are set annually by CMS.
Are there any changes for my Medicare Part A and Part B costs in 2023?
In Medicare Part A, you will see several increases in costs associated with inpatient hospital care from 2022 to 2023:
- A deductible increase from $1556 to $1,600
- A daily copay increase for days 61-90 from $389 to $400
- A daily copay increase for lifetime reserve days from $778 to $800
However, there’s good news for Medicare Part B members. There are small decreases for Part B deductibles and coinsurance rates, which are determined by the Social Security Administration. The deductible cost for Medicare Part B will now cost Medicare beneficiaries $226 in 2023, down $7 from 2022.
You can learn more about these costs and what to expect for 2023 by visiting CMS.gov.
Let ApexAssistants help you!
Nothing makes a challenging health situation worse than having financial stress. We want you to know what’s covered and what you can expect to pay so you can prepare. Please reach out to us with your questions!
Call (844) 279-0508 (TTY: 711) to get more information from an ApexAssistant. Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.