🏥 Understanding Hospitalization Coverage: Original Medicare vs. Medicare Advantage
When it comes to hospital stays, Medicare beneficiaries often wonder: What’s the difference between Original Medicare and Medicare Advantage? The answer matters because a long hospitalization can bring significant financial exposure depending on which type of coverage you have. Let’s break it down simply so you can make the best choice for your situation.
🔹 Original Medicare and Hospital Stays
Original Medicare is divided into Part A (hospital insurance) and Part B (outpatient/medical insurance). When it comes to inpatient hospital stays, Part A is the main player.
Here’s how it works:
Deductible: In 2025, the Part A deductible is $1,632 per benefit period.
Benefit period: A benefit period starts when you are admitted to the hospital and ends when you’ve been out of the hospital (or skilled nursing facility) for 60 consecutive days. You may face more than one benefit period per year, meaning you could pay that deductible more than once.
Daily coinsurance:
Days 1–60: You pay $0 after the deductible.
Days 61–90: You pay $408 per day.
Days 91 and beyond: You use your “lifetime reserve days.” Medicare provides 60 of these days for your lifetime. During those, you pay $816 per day. Once they’re gone, you are responsible for all costs beyond 90 days.
👉 Key takeaway: The 90-day hospitalization rule in Original Medicare means that after 90 days in a hospital (within one benefit period), you’ll start tapping into those lifetime reserve days. That’s a safety net, but it’s a one-time bucket. Once you’ve used all 60 lifetime reserve days, there are no more.
🔹 Medicare Advantage and Hospital Stays
Medicare Advantage (Part C) is private insurance that replaces Original Medicare with a bundled plan. These plans must cover everything Original Medicare covers, but they can structure costs differently.
Here’s how hospitalization works under most Medicare Advantage (MA) plans:
Daily copayments: Instead of one deductible per benefit period, many MA plans charge a fixed daily copay for inpatient hospital stays. For example:
Days 1–5: $300 per day
Days 6 and beyond: $0 per day
Annual maximum out-of-pocket (MOOP): Unlike Original Medicare, Advantage plans have a built-in cap on what you’ll spend in a calendar year. In 2025, the MOOP can be up to $8,850 (in-network). Once you hit this maximum, the plan pays 100% of covered services for the rest of the year.
Network rules: MA plans typically require you to use in-network hospitals (for HMO plans) or pay higher out-of-network costs (for PPOs).
👉 Key takeaway: Medicare Advantage limits your total yearly out-of-pocket spending, but your immediate costs are structured around daily copays rather than benefit periods.
🔹 Example: A 90-Day Hospitalization
Let’s compare a patient hospitalized for 90 consecutive days.
With Original Medicare:
Day 1: You pay the $1,632 deductible.
Days 1–60: $0 per day (covered after deductible).
Days 61–90: $408 per day x 30 days = $12,240.
Total out-of-pocket = $13,872.
If the stay extended beyond 90 days, you’d start using lifetime reserve days at $816 per day.
With Medicare Advantage (example plan):
Days 1–5: $300 per day = $1,500.
Days 6–90: $0 per day.
Total out-of-pocket = $1,500.
(Exact costs vary by plan, but this is a typical design.)
🔹 Which is Better?
The “better” option depends on your health needs, budget, and preferences.
Original Medicare may work well if you want nationwide access with no networks. But hospitalization costs can stack up quickly if you have a lengthy stay. Many people add a Medigap (Supplement) policy to help cover those deductibles and coinsurance.
Medicare Advantage can limit your total financial risk through the annual MOOP. However, you’ll need to follow plan rules, provider networks, and prior authorization requirements.
✅ What You Should Do Next
Review your health history: If you’ve had long hospital stays in the past, factor that in.
Compare your local Medicare Advantage plans to see daily copay structures.
Consider whether a Medigap policy might protect you better if you choose Original Medicare.
Talk to a licensed agent who can run side-by-side comparisons based on your county and health needs.
Bottom Line
Hospitalization coverage can look very different between Original Medicare and Medicare Advantage. The Original Medicare 90-day hospitalization rule can mean high out-of-pocket exposure without a supplement, while Advantage plans trade that risk for daily copays and an annual spending cap.
Making the right choice is about balancing flexibility, costs, and peace of mind.
📍 Need help comparing plans in your area? Visit GenerationHealth.me for a personalized Medicare quote today.