CENTERS FOR MEDICARE & MEDICAID SERVICES

CMS Product No. 11408

Revised December 2014

Medicare.gov 

 Medicare & Your 

Hospital Benefits 

G E T T I N G S T A R T E D

Hospital care when 

you need it 

Know your rights

You have the right to be included in decisions about 

your care, to be treated with dignity and respect, to 

be protected from discrimination, to privacy and 

confidentiality, and to a process to appeal payment 

decisions. For more information on appeals, visit 

Medicare.gov/claims-and-appeals, or call 

1-800-MEDICARE (1-800-633-4227). TTY users should 

call 1-877-486-2048. 

If you’re a hospital inpatient and think you’re 

being discharged too soon, you have the right to 

an immediate review your Beneficiary and Family 

Centered Care Quality Improvement Organization 

(BFCC-QIO). Within 2 days of your admission and 

prior to discharge, you should get a notice called “An 

Important Message from Medicare about Your Rights” 

(sometimes called the “Important Message from 

Medicare” or the “IM”). If you don’t get this notice, 

ask for it. This notice lists your BFCC-QIO’s contact 

information and explains your rights. You can also visit 

Medicare.gov/contacts, or call 1-800-MEDICARE to 

get the phone number for your BFCC-QIO.

“Medicare & Your Hospital Benefits: Getting Started” isn’t a legal 

document. More details are available at Medicare.gov/publications 

in the “Guide to Choosing a Hospital.” Official Medicare Program 

legal guidance is contained in the relevant statutes, regulations, 

and rulings.

Where can I get more information?

•	 To get more information about Medicare costs, coverage, and 

appeals, visit Medicare.gov. You can also call 1-800-MEDICARE 

(1-800-633-4227). TTY users should call 1-877-486-2048.

•	 To get all the information you need before you leave the hospital, 

visit Medicare.gov/publications to view or print the publication 

“Your Discharge Planning Checklist.”

•	 To compare hospitals, visit Medicare.gov/hospitalcompare. 

Hospital Compare gives you a “snapshot” of the quality of the 

hospitals in your area and around the nation. 

•	 To learn about how you can choose a hospital that meets your 

needs, visit Medicare.gov/publications to view or print the 

booklet “Guide to Choosing a Hospital.”

•	 For free health insurance counseling and personalized help 

with insurance questions, call your State Health Insurance 

Assistance Program (SHIP). Visit Medicare.gov/contacts, or call 

1-800-MEDICARE to get the phone number for the SHIP in 

your area. 

•	 If you suspect fraud, visit stopmedicarefraud.gov, or call 

1-800-MEDICARE.
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Let ’s get star ted

Medicare helps cover certain medical services and 

supplies in hospitals. If you have both Medicare 

Part A (Hospital Insurance) and Medicare Part B 

(Medical Insurance), you can get the full range of 

Medicare-covered services in a hospital. 

Find out if you’re a hospital 

inpatient or outpatient

What you pay for hospital services and supplies 

depends on whether you’re an inpatient or an 

outpatient. Staying overnight in a hospital doesn’t 

always mean you’re an inpatient. If you aren’t sure 

whether you’re an inpatient or an outpatient, ask 

your doctor or the hospital staff. For more 

information, visit Medicare.gov/what-medicarecovers/part-a/inpatient-or-outpatient.html. You can 

also call 1-800-MEDICARE (1-800-633-4227). TTY 

users should call 1-877-486-2048.

What’s covered?

If you’re admitted to a hospital as an inpatient, Part A helps cover 

your hospital services. This generally includes a semi-private room, 

meals, general nursing care, drugs as part of your inpatient treatment, 

and other hospital services and supplies. Your Part A coverage doesn’t 

include doctors’ services. Part B helps cover some of the doctors’ 

services you get when you’re a hospital inpatient. 

Note: Medicare measures your use of inpatient hospital and skilled 

nursing facility (SNF) services in “benefit periods.” A benefit period 

begins the day you’re admitted as an inpatient in a hospital or SNF and 

ends when you haven’t had any inpatient hospital care (or skilled care 

in a SNF) for 60 days in a row. You can have more than one hospital 

stay within the same benefit period. There’s a limit on how many days 

Medicare covers during a benefit period, but there’s no limit on the 

number of benefit periods you can have over your lifetime. 

If you’re an outpatient, Part B helps cover services like doctors’ 

services, emergency and observation services, lab tests, and X-rays.

Remember, staying overnight in a hospital doesn’t always mean 

you’re an inpatient.

What’s not covered?

Medicare doesn’t cover the cost of private-duty nursing, a phone or 

television, personal items (like toothpaste), or a private room (unless 

medically necessary). If you’re an outpatient, Part B generally doesn’t 

cover the prescription drugs that you can “self administer” (take by 

yourself). If you have a Medicare Prescription Drug Plan (Part D), these 

drugs may be covered under certain circumstances. Call your plan for 

more information, or visit Medicare.gov/publications to view or print 

the publication “How Medicare Covers Self-Administered Drugs Given 

in Hospital Outpatient Settings.” 

What do I pay?

As a hospital inpatient, you pay:

•	 A one-time hospital deductible for each benefit period

•	 Days 1-60: no coinsurance amount for each benefit period

•	 Days 61-90: a coinsurance amount per day of each benefit 

period

•	 Days 91 and beyond: a coinsurance amount for each “lifetime 

reserve day” after day 90 of each benefit period (up to 60 days 

over your lifetime)

When you’re a hospital inpatient or outpatient, in general, 

you pay 20% of the Medicare-approved amount for most doctor 

services you get after the Part B deductible is met. For hospital 

outpatient services, you generally pay a copayment for each 

individual outpatient hospital service, except for certain preventive 

services. In most cases the copayment can’t be more than the Part 

A hospital stay deductible for each service. If you get hospital 

outpatient services in a critical access hospital, your copayment may 

be higher and may exceed the Part A hospital stay deductible. 

Visit Medicare.gov/your-medicare-costs for the most up-to-date 

information on deductibles, coinsurance, and copayments. You can 

also call 1-800-MEDICARE (1-800-633-4227). TTY users should 

call 1-877-486-2048.