AWCA Resource Center
AWCA Resource Center

Hospital Care

Inpatient Admission

This content is for informational purposes only. For medical advice or diagnosis, consult a healthcare professional. In case of an emergency, immediately call 911.

Inpatient Care refers to health care services provided to a patient who has been formally admitted to a hospital based on a doctor’s order. This level of care is generally required for serious medical conditions, surgeries, or treatments that require continuous monitoring by a medical team.

Hospital Status and Admission

A person is considered an inpatient starting the moment they are formally admitted to the hospital with a physician’s order. It is important to note that staying in a hospital bed overnight—even in the Emergency Room—does not automatically make someone an “inpatient.”

If a patient is placed under Observation Status, they are classified as an outpatient. This distinction matters because it affects how much you pay and whether Medicare will cover follow-up care at a skilled nursing or rehabilitation facility. Time spent under observation does not count toward Medicare’s required 3-consecutive-day inpatient stay for skilled nursing facility (SNF) coverage.

Coverage and Benefits

Medicare Part A (Hospital Facility Costs)

  • Coverage: Covers semi-private rooms, meals, general nursing, drugs provided as part of inpatient treatment, and other hospital services and supplies. Private rooms and private-duty nurses are not covered.
  • Patient Cost: Patient pays the inpatient deductible ($1,736 in 2026) first. Part A covers the rest.
  • Benefit Period: Benefit period begins the day you are formally admitted as an inpatient. If you are readmitted within 60 days of discharge, it counts as the same benefit period—and the same deductible applies. If readmitted after 60 days, a new benefit period begins and a new $1,736 deductible applies. There is no limit on the number of benefit periods.
  • Lifetime Reserve Days:If a hospital stay exceeds 90 days in a single benefit period, Medicare provides an additional 60 days of coverage over your lifetime. Once these reserve days are used up, you are responsible for the full cost of any remaining hospital days.

Medicare Part B (Physician Services)

  • Coverage: Covers physician and surgical services received while you are an inpatient.
  • Patient Cost: Patient pays the annual deductible ($283 in 2026). After that, Part B generally covers 80% of physician costs, and the patient pays the remaining 20%.

     

    *Even during an inpatient stay, physician services are billed separately under Part B and not Part A.

Medicare Advantage (Part C)

  • Coverage: Covers semi-private rooms, meals, general nursing, drugs provided as part of inpatient treatment, and other hospital services and supplies. Private rooms and private-duty nurses are not covered.
  • Prior Authorization: Most Advantage plans require prior authorization (PA) from the insurer before a non-emergency inpatient admission. Skipping this step may result in reduced or denied coverage.
  • Patient Cost: Many plans charge a set daily copayment for the first few days of a hospital stay, after which coverage is typically $0. All costs count toward your plan’s annual Maximum Out-of-Pocket limit.


*Coverage and cost vary by plan—always review your plan details.

Medicaid (NJ FamilyCare)

  • Coverage: Medicaid covers all medically necessary inpatient hospital services for eligible residents.
  • Patient Cost: Medicaid recipients typically have little to no copayment for inpatient hospital stays.
  • Prior Authorization: Some elective (non-emergency) inpatient admissions may require prior authorization from the plan or the state to confirm medical necessity.

    *OBBBA (One Big Beautiful Bill Act) implementations may affect eligibility and program details. Refer to the official website for the most current information.

Private Insurance

  • Coverage: Most private plans cover inpatient admissions, but often require prior authorization unless the admission follows an emergency.
  • In-Network vs. Out-of-Network: Costs are significantly lower when using in-network hospitals. Out-of-network admissions may result in much higher out-of-pocket expenses or no coverage at all for elective procedures.
  • Patient Cost: Some plans charge a per-day copayment for the first several days, while others apply a flat deductible per admission. Cost structures vary by plan—always review your plan documents.

    * In-Network refers to hospitals, physicians, and providers (including doctors, nurse practitioners, and physical therapists) who have a contracted agreement with your insurance plan.
    * Out-of-Network providers do not have a contract with your insurer, which can result in significantly higher out-of-pocket costs.

Cost Sharing by Insurance Type (2026)

Insurance TypeDeductibleCoinsurance / Copayment
Medicare Part A (Hospital
Facility Costs)		$1,736Days 1–60: $0
Days 61–90: $434/day
Days 91+: $868/day (per reserve day).
After reserve days: full cost
Medicare Part B (Physician
Services)		$28320% of Medicare-approved amount
Medicaid (NJ FamilyCare)$0Typically $0 for eligible services
Medicare Advantage (Part C)
Private Insurance		Varies by planVaries by plan; Prior authorization may be required

Hospitals and Providers Search

Inpatient Care Hospitals in Bergen County

The following are non-emergency contacts. In case of an emergency, immediately call 911.

Hospital NameAddressPhone NumberWebsite
Bergen New Bridge Medical Center230 East Ridgewood Avenue, Paramus, NJ 07652201-967-4000newbridgehealth.org
Englewood Health350 Engle Street, Englewood, NJ 07631201- 894-3000englewoodhealth.org
Hackensack Meridian Health-Pascack Valley250 Old Hook Road,
Westwood, NJ 07675		201- 383-1035pascackmedicalcenter.com
Hackensack University Medical Center30 Prospect Avenue, Hackensack, NJ 07601551-996-2000hackensackmeridianhealth.org
Holy Name Medical Center718 Teaneck Road, Teaneck, NJ 07666201-833-3000holyname.org
The Valley Hospital4 Valley Health Plaza, Paramus, NJ 07652201-447-8000valleyhealth.com

Resources

Resources

Hospital Care