Average Cost of Hospital Stays With and Without Medicare

Americans spend billions of dollars each year on healthcare. Without insurance, expensive treatment options may not always be available to people who need them. Keep reading for a look at the breakdown of the costs of a hospital stay with and without Medicare.

Average Cost of a Hospital Stay

According to a 2021 study from the Kaiser Family Foundation (KFF), the average cost of a hospital stay per day in the U.S. was $2,883.

Costs are rising every year, and you can anticipate extra charges depending on your specific location, how many medical professionals you see during the visit.

Average Cost of a Hospital Stay on Medicare

Inpatient hospital care is covered by Medicare Part A (hospital insurance) if you meet both of the following conditions:

• A doctor's order stating you require inpatient hospital care to treat your illness or injury as an inpatient
• The hospital accepts Medicare

A hospital utilization review committee must approve your hospital stay for inpatient hospital care to be covered by Medicare Part A.

You may require more medical treatment than Medicare covers depending on your doctor's opinion. The health provider may recommend you pay for procedures not covered by Medicare. Ask your doctor why certain treatments are suggested and whether Medicare will pay for them if this happens.

Your Medicare Part A will pay the following charges per benefit period:

• Deductible: $1,632 
• Coinsurance for days 1–60: $0 
• Coinsurance for days: 61–90: $408 coinsurance per day
• Coinsurance for days 91 and beyond: $816 coinsurance per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime).
• After the lifetime reserve is met, Medicare pays all costs

Medicare covers the following inpatient hospital services: 

• Semi-private hospital rooms
• Daily meals
• General nursing care 
• Drugs, including methadone to treat opioid disorders
• Other necessary hospital services and supplies as part of your treatment plan

Things Medicare won’t cover:

• Private nurses
• A private hospital room unless your doctor says it is necessary
• Separate charges for a television or telephone in your hospital room
• Personal hygiene items 

Medicare pays for inpatient hospital treatment in these types of facilities:

• Acute-care facilities
• Critical-care facilities
• Rehabilitation centers 
• Psychiatric hospitals 
• Long-term care facilities

Things to Know

Psychiatric care in a mental health facility has a lifetime limit of 190 days.

Inpatient care received as part of a qualifying clinical research study is also covered.

If you have Medicare Part B in addition to Medicare Part A, your Part B will cover 80% of inpatient hospital services approved by your doctor. 

Average Cost of a Hospital Stay Without Medicare

According to National Nurses United (NNU), U.S. hospitals charge $417 for every $100 of their total medical costs. If you happen to be without insurance, you are facing high out-of-pocket costs depending on the type of treatment you need to help make up the difference.

For patients without any insurance including Medicare, statistics from the Agency for Healthcare Research and Quality show the average cost of a day in the hospital is approximately $13,600.

Common Conditions Requiring Hospitalization

Here are some of the most common types of treatment requiring hospitalization along with the cost of the procedure according to the data provided by the NNU:

Factors That Affect Your Hospital Bill

Understanding your hospital bill and the factors that affect your charges can be complicated if you don’t understand all the medical terminology. Here is a breakdown of some of the factors affecting your hospital bill.

When looking at your hospital bill, you should see the charges broken down in this way:

• Charges that have been billed: This is the total amount you or your insurance provider will be charged. The amount that the healthcare practitioner has decided not to charge is referred to as the adjustment.
• Insurance payments: The money you've already received from your health insurance company. 
• Patient payments: The amount you must pay as a patient.

To make sure you are not overpaying your hospital bill, check for these common errors patients have reported finding when examining their hospital bills:

You were not Given a Treatment, Drug or Operation

If you had a test or procedure scheduled, but it was canceled, it may still appear on your bill if it was not removed from your chart.

Minor Typos

You may be charged for 100 tablets instead of 10 if an extra 0 was inserted.

Duplicate Charges

Make certain that a service or operation isn't included more than once. Duplicate charges are surprisingly prevalent. 

Errant Charges

Hospitals deal with hundreds of patients, bills and insurance claims every day. It’s quite easy for a hospital bill to have errant charges. This is why it’s recommended that you request an itemized bill that you can review with the clerical staff at the facility. You may find that there are several errant charges that are slowly eating away at your benefits.

Time in the Operating Room and Under Anesthesia

Check your medical records to see how long you were in the operating room or under anesthesia if you had surgery. Because patients are typically invoiced in 15-minute intervals in these situations, errors can quickly mount up.

Incorrect Patient Information

On medical bills, minor errors such as misspelled names or misprinted policy numbers are prevalent. If your insurance ID number is incorrect, your health plan may deny your claim or bill you the whole amount.

Lodging Fees

Check that you were charged for the correct type of room (shared or private) and the correct number of days if your bill includes a hospital stay. If you were admitted after midnight, ensure your charges begin the next day. In addition, most insurance companies prohibit hospitals from charging room fees on the day of discharge.

Compare Medicare Insurance Options

Do your own comparison shopping to find quality Medicare insurance at a reasonable price. Benzinga has produced a list of the leading Medicare insurance companies to assist you.

Frequently Asked Questions