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Hospital Care (Inpatient) Medicare Coverage Detailed

Your Medicare Coverage

Hospital Care (Inpatient) Detailed

Coverage: Conditions that must be met before Medicare will provide coverage, and limits to coverage.

Medicare Part A covers inpatient hospital care if all of the following is true:

  • A doctor says you need inpatient hospital care for treatment of your illness or injury.
  • You need the kind of care that can be given only in a hospital.
  • The hospital has agreed to participate in the Medicare program.
  • The Utilization Review Committee of the hospital does not disapprove your stay while you are in the hospital.
  • A Quality Improvement Organization or an intermediary does not disapprove your stay after the bill is submitted.

Medicare covered hospital services include: A semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care you get in critical access hospitals and inpatient mental health care. This does not include private duty nursing or a television or telephone in your room. It also does not include a private room, unless medically necessary.

CoPayment: The amount you need to pay.

You pay for each benefit period in 2003:
Days 1 - 60: an inititial deductible of $840
Days 61 - 90: $210 each day
Days 91 - 150: $420 each day

Effective January 1, 2004: The amounts you pay for each benefit period will increase to the following amounts:
Days 1 - 60: an initial deductible of $876.
Days 61 - 90: $219 each day.
Days 91 - 150: $438 each day.

A benefit period begins the day you go to a hospital (or under special circumstances, a skilled nursing facility). The benefit period ends when you have not received hospital or skilled nursing care for 60 days in a row. If you go into the hospital after one benefit period has ended, a new benefit period begins. There is no limit to the number of benefit periods you can have.

Lifetime reserve days give you an extra 60 days of inpatient coverage when you are in a hospital for more than 90 days. These 60 reserve days can be used only once during your lifetime.

Medicare Part: The part of Medicare that pays for this service or supply.


Organization Name: The organization name that this coverage topic is associated with.

Important Notes: Details regarding important notes about the coverage.