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Does Medicare Have Limitations on Hospital Stays?

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By Daniel Petkevich
Mar 15, 2024

Medicare Part A provides coverage for hospital inpatient care, but it is subject to certain limitations. Once you have used up your Medicare Part A hospital inpatient days, you may be responsible for covering the costs of any additional inpatient care you receive during the same benefit period.

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Here's a breakdown of what happens when you exhaust your Medicare Part A hospital inpatient days:
  1. Benefit Period: Medicare Part A measures your hospital coverage based on benefit periods. A benefit period begins the day you're admitted to a hospital or skilled nursing facility and ends when you've been out of the hospital or skilled nursing facility for 60 consecutive days. If you're readmitted after the end of a benefit period, a new benefit period begins, and you will have a new set of inpatient hospital days available.
  2. Costs After Using Inpatient Days: Once you've used up your allotted inpatient hospital days within a benefit period (90 days), Medicare Part A coverage for inpatient care typically stops. You may be responsible for all hospital costs during this period, including room and board, medical services, and supplies. Sixty 'reserve' days per lifetime may be used if needed) However, Medicare Part B may still cover certain outpatient services and medical supplies.
  3. Part A Deductible and Coinsurance: Medicare Part A also has deductible and coinsurance amounts you may need to pay. There is a deductible for each benefit period and coinsurance amounts for extended hospital stays. These amounts may change annually, so checking with Medicare or your healthcare provider for the most up-to-date information is important.
  4. Medicare Advantage Plans: If you have a Medicare Advantage plan (Part C), your coverage for inpatient hospital care may differ from Original Medicare (Parts A and B). Some Medicare Advantage plans offer additional benefits or different cost-sharing arrangements, so reviewing your plan's terms and conditions is essential.
  5. Medigap/Supplement Plans: If you have a Medicare Supplement (Medigap) plan, it can fill in some gaps in your Original Medicare (Parts A and B). For example, Medigap Plan G will extend your Part A coinsurance up to 365 days, cover you hospital deductible, and skilled nursing co-pays.
  6. Out-of-Pocket Costs: If you need extended inpatient hospital care and no longer have Medicare Part A days available, you may have to pay for these services out of pocket unless you have other supplemental insurance coverage.
It's crucial to understand your Medicare coverage and its limitations. If you anticipate needing extended hospital care or have specific healthcare needs, it's a good idea to explore additional coverage options, such as Medicare Supplement Insurance (Medigap) policies, to help offset some of the out-of-pocket costs associated with inpatient care. Schedule a chat with one of our Medicare experts to discuss coverage by scheduling an appointment at

fairsquaremedicare.com

or calling 1-888-454-2383. We're looking forward to talking to you!

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