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Hospital Stays and Coverage Options

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Financial

While you can hope that you never need them, the truth is that you can never know when you’ll need hospital services. If you don’t have insurance, hospital bills could easily cost you an arm and a leg and leave you in debt for a long time. And even if you do have insurance, you could still end up paying a ton out of pocket. That’s why it is important to know more about your insurance and what it covers. Whether on private insurance, Medicare or Medicaid, knowing what your insurance will cover can prepare you for what you can expect to pay. Read on to learn more about insurance coverage for hospital services and what it can do for you.

Insurance Coverage

Insurance cover from a private insurer can vary based on the type of care as well as your policy. Outpatient care at a hospital usually requires you to stay only for a short period of time. Your condition will usually not be severe enough to warrant a longer stay. Most insurers will cover a majority of your visit, provided there was at least a medical necessity. It’s also usually less expensive on its own, so you’ll have lower out of pocket costs. Less of the hospitals resources are used reducing this cost. However, with inpatient care, longer stays will be required, which means more fees and higher out of pocket costs. Copays can be structured based on a per stay or per day visit, with copays of just a few hundred dollars or up to a Grand.

Highlights:

  • Must be medically necessary
  • Copays structured by per stay or per day
  • Copays can go up to $1,000

Medicare

Hospital services are covered under Medicare Part A.  Medicare Part A covers all hospital services, including semi-private boarding, nursing, drugs and meals. Medicare will cover acute care, long-term care and critical access in hospitals, depending on what you need. However, Medicare will not cover private rooms unless deemed medically necessary. Additionally, it will not cover private nursing, amenities or personal care items. In order to be covered by Medicare, there must be a doctor’s order requiring 2 or more nights at a hospital as medically necessary. The stay must also be approved by the Utilization Review Committee, and be the kind of care only suitable in a hospital environment. The costs to you for a hospital stay may be around $1,316 in deductibles, and $0 coinsurance for a 60 day period. Up to 90 days and the coinsurance costs can be $329 and over 90 days the cost can be $658.

Highlights:

  • Covers semiprivate rooms and nursing
  • Drugs and meals covered
  • Private nursing not covered

Medicaid

Because Medicaid is for families with exceedingly low incomes, only the basic levels of medical care are covered with little to no copays. Medicaid coverage will differ depending on the state in which you live. In Ohio for instance all beneficiaries of Medicaid are eligible for inpatient care with a $0 copay. However, hospital stays must be less than 30 covered days from the admission date and 60 days after discharge. There are very few exceptions to this rule. Surgeries may require approval, but chemical dependency detox is usually covered.

Highlights:

  • Coverage varies by state
  • $0 copay
  • Hospital stays covered 60 days after admission