Retirees may know that Medicare doesn’t cover inpatient hospital costs forever, because Medicare Part A covers the first 60 days of the cost for time spent in the hospital after you’ve reached your deductible. Beginning on day 61, beneficiaries must pay a daily coinsurance amount. For very long hospitalizations, patients may ultimately be responsible for all costs.
However, paying attention to the number of days Medicare will pay your hospital costs only gives part of the picture for seniors. It is also important to understand that Medicare does not cover certain costs of hospital services, even for the first 60 days of inpatient care. Such services go beyond what Part A approves.
These types of hospitalization and healthcare costs can surprise retirees because understanding what Medicare does and doesn’t cover can be extremely confusing. A recent eHealth survey shows that 75% of beneficiaries feel confused about choosing the right Medicare plan. Learning more about what Part A does not cover can clear up some of the confusion about hospital costs and Medicare coverage. The most common hospital services that Medicare does not cover include private rooms and private nursing care. However, you may also receive unpaid fees for unusual situations, such as a TV or phone that needs to be added to the room, personal care items for which the hospital charges extra, and even the first three pints of blood received in a transfusion.
Read more: You’ve been warned: Medicare won’t cover these 13 medical costs for seniors
Medicare Part A usually does not cover private rooms
Private room in a hospital – Imaginima/Getty Images
One of the most expensive items you may have during a hospital stay that Medicare Part A does not cover is a private room. A private room is defined as one that the Medicare beneficiary does not share with another patient, while a semi-private room usually has at least two patient beds separated by a curtain or partition. How much you pay depends on the hospital and its individual rates, but private rooms are more expensive than semi-private rooms. If a patient chooses a private room, they will have to pay the difference in cost between the semi-private and private room.
Medicare offers some exceptions to the private room rule. If you are hospitalized and semi-private rooms are not available, you will not be charged for the private room. In addition, some hospitals may only offer private rooms, and you will not be charged an additional fee in this case. Also, your doctor may find that having a private room is a medical necessity for you. Medicare defines medical necessity as care that is “reasonable and necessary” for diagnosis or treatment, based on evidence. This designation may occur if the patient has a communicable disease that could place a second patient in the room at risk of contracting it. In addition, a patient may need a private room because the doctor believes that isolation increases the chances of a full recovery.
A private nurse for hospital care is not covered
Private nurse talking to an elderly patient – Halfpoint/Getty Images
If you choose to hire a private practice nurse (PDN) to help with your care while you are in the hospital, Medicare will not cover the costs of this skilled professional’s individual work. Some patients who use a private home health aide may wish to continue this care during their hospital stay. Medicare does not cover 24-hour medical care in your home, nor will it cover this expense in the hospital.
A private nurse is a trained or licensed professional attendant hired to help with care. Often, these people are registered nurses or registered nurses. This professional would provide one-on-one care, usually for someone who has a medical problem that requires a continuously available caregiver. Hiring a PDN at your home is more common than having one at the hospital. They can provide the focused care you need to stay healthier and avoid having to go to the hospital as often.
However, this type of focused, personalized care is not part of normal hospital services because PDNs are not on staff. Instead, hospitals provide nurses who care for multiple patients during their shifts, the nurse-to-patient ratio depending on the type of care provided and the patients’ level of illness.
If a TV or telephone in a room has an extra cost, you will pay it
Patient watching television in a hospital room – S-cphoto/Getty Images
Although most hospital rooms have a television to distract and keep patients at bay from boredom, not all types of rooms have televisions, including some associated with mental illness care or intensive care. Older hospital rooms may not have space for televisions. Rooms where infection control needs to be at its highest might skip TVs and remotes. Also, a room created for multiple people might not include a TV because it would generate unwanted noise.
Some hospitals include televisions in every room, but the facility occasionally adds a television usage fee to the bill. If a hospital charges extra for TV use, or if the patient requests a TV for a room that doesn’t have one and receives a fee, Medicare Part A will not cover the cost
Hospitals have long used landlines for reliable communications, including having these corded phones in patient rooms that patients can often use for free. However, if the hospital charges you to use the landline phone in the room, charges you for long-distance calls, or bills you for adding a phone to a hospital room that normally doesn’t have one, Medicare Part A doesn’t reimburse the cost of the phone.
Medicare does not cover additional costs for personal items
Person combing the hair of an elderly hospital patient – surachet khamsuk/Shutterstock
When you go to the hospital for inpatient care, you may have to leave home in a hurry because of an emergency. Also, you may not know how long you will be staying. In these situations, it’s common for people to not anticipate some of the personal care items they need to bring. If you need personal care items during a hospital stay and the hospital costs for them, Medicare Part A will not cover these costs.
Depending on your health situation, some of the personal care items you may want during a hospital stay include razors, slippers, shampoo, toothpaste, a toothbrush, lip balm, deodorant, and hand lotion. If you receive some of these items from the hospital during your stay, they may list them as supplies instead of splitting the cost of each item, which can make it difficult to understand why Medicare won’t cover them. Some hospitals charge for all personal care items, while others do not.
If you are worried about paying for these items, you should ask family members to bring anything you forgot. If you know you’ll be going to the hospital in a few days, take the time to pack a bag that contains all the personal items you think you might need.
Sometimes Medicare will not reimburse the cost of blood
Blood bag hanging for a transfusion – WijeClick/Shutterstock
While there are many Medicare mistakes that retirees should take steps to avoid, some extra costs during a hospital stay that Medicare Part A won’t reimburse are partly out of your control. If you need a blood transfusion while in the hospital, Medicare Part A will usually cover the cost of the transfusion. However, if the hospital buys blood and charges for it on your hospital bill, Medicare Part A may not cover the cost for the first three pints you receive.
If the hospital has enough blood type on hand and doesn’t need to purchase it, they may not charge you. In this case, since there is no additional charge on the hospital bill, there is no concern about Medicare Part A coverage.
Patients can sometimes avoid this fee by replacing the blood by donation, either personally or through a family member. You can donate blood before or after having an inpatient procedure at the hospital. As long as someone donates and replaces the required three pints of blood, Medicare will not charge an additional fee. If you receive plasma instead of whole blood for your procedure, the fee is usually waived.
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