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In a previous article 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 Medicare 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 Lifetime Reserve 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 just the basic 60 days. Check
your or your parent's policy for information about
Lifetime 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.
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