OBJECTIVES: To estimate the mean cost per episode of hospitalization for patients with heart failure (HF). METHODS: A retrospective analysis was undertaken using a large US claims database, the Optum Research Database.  Adult patients with a first observed inpatient HF claim (ICD-9: 428.xx; in primary position) between 01/01/08 and 06/30/13 were included. Patients having an inpatient claim for HF in the 2 months prior to the first observed claim were excluded. Direct costs included the amount paid by insurance plan, co-ordination of benefits and patient out-of-pocket costs.  Cumulative hospitalization rates were estimated for all HF-related hospitalizations, cardiovascular (CV) hospitalizations and all-cause hospitalizations, within the study period.  Results were further categorized by types of insurance, specifically, commercial and Medicare advantage. RESULTS: A total of 85,938 patients met the study criteria of which 68.3% (n=58,732) had Medicare Advantage coverage and 31.7% (n=27,206) had commercial insurance. The mean age was 63 years for patients with commercial insurance and 77 years for those with Medicare advantage.  For the total population (commercial + Medicare advantage), the mean direct costs were approximately $30,900 for a HF- related hospitalization, $30,400 for CV-related hospitalization, and $25,400 for an all-cause hospitalization.  For patients with commercial insurance, the mean costs were approximately $48,500, $47,700 and, $40,000 for a HF-related, CV-related, and all-cause hospitalization episode, respectively.  For patients with Medicare advantage, the mean costs were approximately $23,800, $23,400 and $19,600 for HF-related, CV-related, and all-cause hospitalizations, respectively.     CONCLUSIONS: Hospitalizations for patients with HF are costly. On average hospitalizations due to worsening HF could range from $23,800 to $48,500 depending on the type of coverage. The costs of hospitalizations were higher in patients with commercial insurance when compared to Medicare advantage patients.