Key takeaways
- Medicare Part A does not cover outpatient surgery.
- Your hospital status could be inpatient or outpatient, and the status will determine how Medicare covers eligible costs.
- If staying overnight or for longer, it is important to check your status with the hospital daily to avoid any unexpected charges.
Medicare Part A covers eligible inpatient treatment, drugs, dressings, accommodation, and meals that you need during a hospital stay.
If you are admitted to a hospital for what’s considered to be a day-case surgical procedure, Part A will cover the costs, even though you will typically go home the same day. A day-case procedure is often considered more complex than an outpatient surgery.
Part B covers outpatient treatment and services as well as some prescription medications you receive in a doctor’s office. If a surgical procedure is considered outpatient, it is likely a routine procedure that should see you on your way home much sooner than if it were a day-case procedure.
Medicare Part A does not cover outpatient surgery, and it’s really important for the hospital to confirm your hospital status.
Your hospital status will typically be inpatient or outpatient. Sometimes, the hospital may decide that a surgical procedure is a day-case procedure, but Medicare would classify it as an outpatient surgery.
Here are the general differences between the hospital statuses:
| Inpatient | requires you stay overnight or longer |
|---|---|
| Day-case | requires you to stay in the hospital for more than approximately 4 hours |
| Outpatient | allows you to go home the same day, often after between 1 and 4 hours |
How the hospital or healthcare facility classifies the procedure you are having will determine your hospital status, and your hospital status will determine your out-of-pocket expenses.
In 2025, the Part A deductible is $1,676, which you must meet before Medicare covers eligible costs. They will then cover eligible costs in full for up to 60 days.
The 2025 Part B deductible is $257, and you must meet this amount before Medicare pays 80% of eligible costs.
Your hospital status can also affect other aspects of your coverage. For example, it may affect whether Medicare will cover treatment in a skilled nursing facility (SNF) after your hospital stay.
Unless a doctor has written an order that admits you to a hospital, you’re considered an outpatient. This applies even if you end up staying overnight.
Outpatient care also includes emergency department services, lab tests, X-rays, observation services, and outpatient surgery.
Doctors and healthcare professionals typically decide you should stay in the hospital if they think you will need treatment for 2 midnights. If the doctor does not order a hospital admission, Medicare Part B may cover you. The out-of-pocket costs could be higher, though.
It is helpful to check with the hospital each day you are there to confirm whether you are an inpatient or outpatient. This may help you avoid unexpected charges.
New rules starting January 1, 2025, allow you to lodge an appeal on denied claims with status changes.
If you have had a claim denied after January 1, 2009, because the hospital changed your hospital status from inpatient to “outpatient getting observation services,” you may be able to lodge an appeal, as this would have affected coverage.
There are also some upcoming changes relating to hospital status changes.
As of February 14, 2025, you can request a fast appeal while you’re still in the hospital if you were admitted as an inpatient and the hospital changed your status to “outpatient getting observation services.” Medicare advises it will have further details and instructions on how to file these types of appeals soon.
Medicare Part A does not cover outpatient surgery.
Your hospital status could be inpatient or outpatient, and the status will determine how Medicare covers eligible costs.
As an inpatient, you must pay the first $1,676 to meet the Part A deductible. Medicare will then cover eligible costs in full for up to 60 days.
However, if you are an outpatient, you will pay the first $257 deductible and then 80% of the costs.
If staying overnight or for longer, it is important to check your status with the hospital daily to avoid any unexpected charges.