Medicare and Medicaid costs

Medicare and Medicaid costs are set by federal rules more than by any one hospital, which makes them predictable if you know which rule applies. For Medicare, the most expensive surprises come from labels rather than prices: whether a hospital stay was inpatient or outpatient observation, and whether a later skilled nursing stay qualifies for coverage. For Medicaid, the key question is often timing: how far back coverage reaches for bills that arrived before the application.

The guides in this section explain those rules from the primary sources, CMS, Medicare.gov, the Code of Federal Regulations and the statute itself, with each figure dated. The 2026 Medicare amounts are used where they apply; 2027 Part A and Part B amounts had not been announced when these pages were checked, and the pages say so rather than estimate them. The 2027 Medicaid changes enacted in Public Law 119-21 are described as written in the law.

Coverage decisions belong to Medicare, your plan, or your state Medicaid agency. These pages explain the cost consequences so you can ask the right office the right question.

Two dates matter this year. For Medicare, the 2026 Part A deductible of $1,736 and Part B deductible of $283 apply through December 31, 2026; the 2027 amounts had not been announced when these pages were checked. For Medicaid, applications made on or after January 1, 2027 can reach back only one or two months for care already received, instead of the three months the federal rule allows today; some states, such as Arizona, already allow less under federal waivers. Both changes reward acting early: knowing your hospital status while you are still in the hospital, and applying for Medicaid soon after a hospital stay rather than after the bills arrive. Each guide below ends with the specific questions to ask and the office that can answer them.

Telehealth is the newest cost rule in this section. Through December 31, 2027, Medicare pays a video visit to a patient at home at the same rate as an office visit, and the telehealth guide below shows the 2026 anchors by visit level, the originating site fee, and the rules that change on January 1, 2028.

The procedure pages on this site serve Medicare beneficiaries in the same way: where a code is paid through a hospital APC, each one shows the minimum national hospital copayment next to the physician fee schedule anchor, which together describe the two Part B cost-sharing amounts an outpatient service usually produces.