Medicare Hospital and Surgical Bills: Inpatient and Outpatient Coverage

Adapted from Your Medicare Benefits, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Inpatient hospital care

Part A usually covers inpatient hospital care if you meet both of these conditions:

• You’re admitted to the hospital as an inpatient with a doctor’s order, which says you need inpatient hospital care to treat your illness or injury.
• The hospital accepts Medicare.

Medicare-covered inpatient hospital services include:

• Semi-private rooms
• Meals
• General nursing
• Certain drugs (including methadone to treat an Opioid Use Disorder)
• Other hospital services and supplies you might get as part of your inpatient treatment

Medicare doesn’t cover these items and services:

• Private-duty nursing
• A television or phone in your room (if there’s a separate charge for these items)
• Personal care items (like toothpaste, razors, or slipper socks)
• A private room, unless medically necessary

Costs What you pay for each benefit period in 2026 depends on how long you’re getting care:

• Days 1–60: After you pay the $1,736 deductible, you pay $0 each day.
• Days 61–90: You pay $434 each day.
• Days 91–150: You pay $868 each day while using your 60 lifetime reserve days. These are additional days that Medicare will pay for when you’re in a hospital for more than 90 days. You have a total of 60 reserve days that can be used once during your lifetime.
• After Day 150: You pay all costs.

Part A only pays for up to 190 days of inpatient mental health care in a freestanding psychiatric hospital during your lifetime. The 190-day limit doesn’t apply to care you get in a Medicare-certified “distinct part” psychiatric unit (a physically separate section of an acute care or critical access hospital that provides inpatient psychiatric care).

If you also have Part B, it generally covers 80% of the Medicare-approved amount for doctors’ services you get while you’re in a hospital.

Things to know Inpatient hospital care includes care you get in:

• Acute care hospitals
• Critical access hospitals
• Inpatient rehabilitation facilities
• Long-term care hospitals
• Inpatient psychiatric facilities

It also includes inpatient care you get as part of a qualifying clinical research study.

Note: Hospitals must now share the standard charges for all their items and services (including the standard charges that Medicare Advantage Plans negotiate) on a public website to help you make more informed decisions about your care.

More information

• Go to:
• “Inpatient rehabilitation care” below.
• “Mental health & substance use disorder services” on page 70.
• “Organ transplants” on pages 79–80.
• “Outpatient hospital services” on pages 82–83.
• “What do I pay for Part-A covered services?” on pages 3–4 to learn more about benefit periods.
• Visit Medicare.gov/coverage/inpatient-hospital-care.

Outpatient hospital services

Part B covers many diagnostic and treatment services you get as an outpatient from a hospital that takes Medicare.

Covered outpatient hospital services may include:

• Emergency or observation services, which may include an overnight stay in the hospital or services in an outpatient clinic (including same-day surgery).
• Laboratory tests billed by the hospital.
• Mental health care in a partial hospitalization program (if a doctor or other qualified mental health professional certifies you’d need inpatient treatment without it).
• Intensive outpatient programs for mental health conditions (including substance use disorders).
• X-rays and other radiology services billed by the hospital.
• Medical supplies, like splints and casts.
• Preventive and screening services.
• Certain self-administered drugs and biologicals you get as part of your service or procedure (like certain injectable drugs).

Costs

• You usually pay 20% of the Medicare-approved amount for the doctor’s or other health care provider’s services. You may pay more for services you get in a hospital outpatient setting than you’d pay for the same care in a doctor’s office. However, the hospital outpatient copayment for the service can’t be more than the inpatient deductible amount ($1,736 in 2026).
• In addition to the amount you pay the health care provider, you’ll usually pay the hospital a copayment for each service you get in a hospital outpatient setting (except for certain preventive services that don’t have a copayment). 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.
• The Part B deductible applies, except for certain preventive services.

More information

• Go to:
• “Mental health care (outpatient): Intensive outpatient program services” on pages 73–74.
• “Mental health care (outpatient): Partial hospitalization” on pages 74–75.
• “Outpatient medical & surgical services & supplies” below.
• “Preventive & screening services” on page 92.
• Visit Medicare.gov/coverage/outpatient-hospital-services.
• To get average costs for a surgery in a hospital outpatient department, visit Medicare.gov/procedure-price-lookup.

Ambulatory surgical centers

Ambulatory surgical centers are outpatient facilities that perform surgical procedures. In most cases, ambulatory surgical centers release patients within 24 hours. Part B covers facility service fees for approved surgical procedures you get in these centers.

Costs

• After you meet the Part B deductible, you pay 20% of the Medicare-approved amount to both the ambulatory surgical center and the doctor(s) who treat you.
• You pay nothing for certain preventive services (like a screening colonoscopy) if your doctor or other health care provider accepts assignment. However, you may have to pay other costs associated with the preventive services. For example, if your health care provider removes a polyp during a screening colonoscopy, you may have to pay 15% of the Medicare-approved amount.
• You also pay all facility fees for non-covered procedures you get in ambulatory surgical centers.

More information

• Visit Medicare.gov/coverage/ambulatory-surgical-centers.
• To get average costs for a surgery in an ambulatory surgical center, visit Medicare.gov/procedure-price-lookup.

Anesthesia

Anesthesia is a type of medication that keeps you from feeling pain during surgery or other medical procedures. Part A covers anesthesia services you get as a hospital inpatient. Part B covers anesthesia services you get as an outpatient in a hospital or as a patient in a freestanding ambulatory surgical center.

Costs

• After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for the anesthesia services you get from a doctor or certified registered nurse anesthetist. The anesthesia service must be associated with the underlying medical or surgical service, and you may have to pay an additional copayment to the facility.
• For Part A inpatient hospital cost information, go to pages 58–59.

More information Visit Medicare.gov/coverage/anesthesia.

Outpatient medical & surgical services & supplies

Part B covers approved outpatient services and supplies, like X-rays, casts, stitches, or outpatient surgeries.

Costs After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for doctor or other health care provider services. You also generally pay a copayment for each service you get in a hospital outpatient setting. In most cases, the copayment can’t be more than the Part A hospital stay deductible for each service you get. You pay all costs for items or services that Medicare doesn’t cover.

More information Visit Medicare.gov/coverage/outpatient-medical-surgical-services-supplies.

Second surgical opinions

A second opinion is when another doctor or health care provider gives their view about your health problem and how it should be treated. In some cases, Part B covers a second surgical opinion for medically necessary, non-emergency surgery. Medicare also covers a third surgical opinion if the first and second opinions are different.

Costs After you meet the Part B deductible:

• You pay 20% of the Medicare-approved amount for a second opinion. The second health care provider may ask you to get additional tests as a result of the visit. Medicare will cover these tests, just as it covers other services that are medically necessary.
• You pay 20% of the Medicare-approved amount for a third opinion, if the second opinion is different from the first opinion.

More information Visit Medicare.gov/coverage/second-surgical-opinions.

Emergency department services

Part B usually covers services you get in a hospital emergency department when you have an injury, a sudden illness, or an illness that quickly gets much worse.

Costs

• You pay a copayment for each emergency department visit and a copayment for each hospital service you get.
• After you meet the Part B deductible, you also pay 20% of the Medicare-approved amount for your doctor’s services.
• If your doctor or other health care provider admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don’t pay the copayment(s) because Medicare considers your visit part of your inpatient stay.

Things to know Medicare only covers emergency services outside the U.S. in rare situations.

More information

• Go to “Travel outside the U.S.” on pages 110–111.
• Visit Medicare.gov/coverage/emergency-department-services.

Urgently needed care

Part B covers urgently needed care to treat a sudden illness or injury that isn’t a medical emergency and/or life threatening.

Costs After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for your doctor or other health care provider’s services. In a hospital outpatient setting, you also pay a copayment.

More information

Visit Medicare.gov/coverage/urgently-needed-care.

Source and further reading

Your Medicare Benefits — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.