Does Medicare Cover Hospital Stays?

Does Medicare Cover Hospital Stays?

Medicare covers hospital stays only if you have been admitted for medical treatment. If the stay is for medical treatment, Medicare will pay for at least some of your room and board. Medicare won't cover the cost of food, lodging, or other expenses for family members who are admitted with you. To learn more, see the section entitled Hospital Stays.

Does medicare pay for treatment for the same condition in different hospitals?

Medicare will pay for more than one hospital stay in a 12-month period for the same condition if each stay meets the following requirements:

you needed the treatment in a hospital,

the first stay began within 7 days of the completion of the previous stay,

the stays were at least 30 days apart, and

the stays were in different locations.

Medicare will pay for the second (or more) hospital stays only if each stay began within 30 days after the completion of the previous stay.

For more information about Medicare coverage for hospital stays for the same condition in different hospitals, see the section entitled “Receiving Treatment in Different Locations.”

Is the hospital or the doctor's office responsible for arranging the Medicare billing?

The hospital must file Medicare bills for services it gives you (except for ER services), whether or not you see a doctor. The doctor's office files bills for the services the doctor gives you.

Can Medicare refuse to pay for hospital care?

Medicare won't pay for care that is medically unnecessary or that is given in an unauthorized place. It also won't pay for treatment that was not given by a doctor on the hospital staff.

Will I have to pay for Medicare hospital care?

Medicare does not pay for hospital care in full. You will have to pay for part of the cost of your care, known as a coinsurance amount. You will also have to pay for your prescription drugs, but you won't have to pay more than a certain amount per prescription.

For more information about Medicare's payment policies, see the section entitled “Coinsurance and Copayments.”

If I'm in the hospital, how will I get my Medicare card?

When you are admitted to a hospital, Medicare will send you a card showing your name and Social Security number. You need this card to get Medicare benefits. The card also shows your Medicare number. Other information about your hospital stay (such as your name, the name of your doctor, and the hospital's address and phone number) is on a separate sheet. Medicare will send this separate sheet to your hospital. This separate sheet is called the Medicare Summary Notice.

In most cases, you can request a copy of the Medicare Summary Notice from the hospital. The Medicare Summary Notice will tell you who to contact if you need help with Medicare or questions about Medicare.

For more information about the Medicare card, see the section entitled “Medicare Cards.”

What should I do if I lose my Medicare card?

You should call the Social Security office at 1-877-690-1012 or go to your local Social Security office to report the loss.

You should also tell the hospital's business office that your card has been lost. The hospital can take steps to protect you from fraud.

What should I do if I moved after going to the hospital?

Tell the hospital that you have moved. Medicare will mail your Medicare Summary Notice to your new address. The hospital may either keep your old address on file or may send the notice to your new address.

Do I need to tell my doctor about my move?

Yes. As soon as you move, you should tell your doctor, your other doctors, and your other health care providers. This is especially true if you move to a new city or state.

What should I do if I change doctors?

As soon as you change doctors, you should tell your new doctor that you have Medicare.

If your doctor will be doing a lot of services for you, he or she should give you a written notice explaining Medicare's rules and benefits. This written notice is called the Medicare Summary Notice. It will show what Medicare pays for and what you have to pay.

If you change doctors, you should also tell your other health care providers. This is especially true if you change doctors to a new city or state. You'll want to tell your new doctors, dentists, and other providers that you have Medicare.

You should also tell your new doctors that you have Medicare.

You should give your other doctors and providers a copy of your Medicare card. This is especially important if you moved.

What should I do before having surgery?

Before having surgery, you should ask your doctor when you should stop taking any medicines that might make your surgery risky for you.

Before you have surgery, you also should make sure that you have a sample of your blood to give to the doctor who will do the surgery.

What happens if I have a surgical emergency?

Medicare covers emergency care in a hospital.

This care includes help in an emergency room and care in a hospital's Intensive Care Unit (ICU), if you are in the ICU for emergency care.

If you are admitted to a hospital for surgery and you have a surgical emergency during the surgery, Medicare will cover the surgery and the emergency care.

Does Medicare cover emergency care at an ER?

Medicare covers emergency care at an ER. It pays only for necessary care, and the care must be given at the ER. ERs are only for emergency care. You must go to a hospital emergency room to receive emergency care.

If you have Medicare Part B and you go to the ER, you may have to pay 50% of the Medicare-approved amount for the hospital services you receive. You can choose to have Medicare pay the hospital the full amount on your behalf, and then you will have to

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