Medicare Maze For Caregivers: Lifetime Reserve Days Medicare's "Last Resort"

In our last issue we talked about Medicare Benefit Periods. In looking at Benefit Periods, it almost sounded like it would be a good idea just to stay in the hospital. Here's why that wouldn't work...

Medicare limits the number of days you may stay in the hospital per Benefit Period to 90. Medicare will pay for up to 90 hospital days per Benefit Period.

After 90 days you must leave the hospital and have no in-patient care for 60 consecutive days in order to re-set the Benefit Period clock. There is no limit to the number of hospitalizations you may have in your lifetime, so long as the clock has been reset by remaining out of the hospital or Medicare-covered skilled nursing for 60 days between stays.

Now, very few people are in the hospital for 90 days, but what happens if you are one of the unlucky few? What if you or a loved one go back to the hospital two or three times within a benefit period? Under these conditions it wouldn't be hard to use 90 hospital days.

Medicare has something called "Lifetime Reserve Days." Lifetime Reserve Days are 60 additional hospital days that Medicare will pay for after the first 90 without having to re-set the Benefit Period clock. Each of these 60 additional days can be used only once in your lifetime. They cannot be replenished. During these 60 Reserve days Medicare will pay all covered costs except for a daily co-insurance amount of $476 per day (2006). Medicare Secondary (MediGap) Insurance often covers this daily co-payment charge. Check your policy.

You use your Lifetime Reserve Days one at a time. If your hospitalization exceeds the maximum by only 5 Reserve Days, then you have 55 of the initial 60 Reserve Days remaining to use any time in your lifetime.

Many MediGap plans will cover up to an additional 365 additional Reserve Days, rather than only 60 days. Check your or your parent's policy for information about Reserve Day coverage.

You may never have to worry about Reserve Days, but it's important to know what they are and how they work, especially if you are managing someone's care. Understanding the basics of how this part of Medicare works is especially important if you are managing the care of someone who is moving back and forth between hospitals and rehabilitation facilities, as Medicare days can be exhausted before you are aware that there might be a problem.

This information applies to traditional Medicare. If you are working with a Medicare Advantage (Medicare HMO) you will have to check with your insurance company.

By the time a man realizes that his father was usually right, he has a son who thinks he's usually wrong. ~ Unknown

House Calls Are Coming Back

Do you care fore someone who can't easily get out to see a doctor? More doctors and nurse practitioners are making house calls these days. If you live in a very rural area you might have trouble finding one. If you live in a more populated area there are more every day. Larger medical practices are moving toward nurse practitioners who make house calls. Nurse Practitioners are registered nurses who have completed additional specialized training. In many areas they can write prescriptions and work without the direct supervision of doctors. When a nurse practitioner makes a visit to your loved one at home and finds a medical condition that warrants the attention of a doctor he or she will often request that a practice doctor make a visit. The American Academy of Home Care Physicians has a website where you can look for one in your area. Not all physicians making house calls are members of the Academy. You can also ask at your local senior center, a senior medical clinic, or ask a geriatric care manager. As a last resort, the Eldercare Locator - (800) 677-1116 - may be able to give you a referral.

If you can find a path with no obstacles, it probably doesn't lead anywhere. ~ Frank A. Clark