What You Need To Know About Medicare Lifetime Reserve Days
Toni,
Why did a hospital medical claims division employee ask my husband to sign a form stating that he’s aware that he’s now in his “Lifetime Reserve Days” while he was waiting for his lung/heart transplant?
James went into the hospital in December of last year for congestive heart failure. Unfortunately, that’s when he discovered that his heart and lungs could no longer support him. The wait for this double transplant is taking longer than expected. I’m now concerned that the hospital will send him home or to a nursing home. Please explain what James needs to do. He’s covered by Medicare Supplement Plan G and has had no issues with that plan.
Thanks, Toni,
Alice
Hi Alice,
If a Medicare beneficiary uses all of their standard coverage days in a benefit period but still needs hospital care, they can use their lifetime reserve days. Beneficiaries are typically given a total of 60 lifetime reserve days throughout their lifetime. These reserve days can be used for additional hospital stays beyond the standard coverage limit.
What does this mean for your situation? Allow me to explain.
Lifetime Reserve Days
James is past the Inpatient Hospitalization 60 lifetime reserve days, so Medicare has stopped paying and the stay is his responsibility. For 2024, Medicare Part A covers an inpatient hospital stay with a $1,632 deductible for days 1 through 60. Yes, an Inpatient hospital deductible of $1,632 can happen 6 times a year. This includes a semi-private room and board, general nursing, and miscellaneous services and supplies.
NOTE: If your Part A-Inpatient Hospital stay is longer than 60 days, then for days 61 through 90 Medicare pays all but $408 per day!
For days 91 and after, Medicare will pay all but $816 per day with the 60 “lifetime reserve days” to be used. Once the Medicare lifetime reserve days are used, then the “inpatient hospital benefits” are exhausted. You will pay all the cost of the remainder hospital stay.
Alice, I have good news for James.
The Magic of Medicare Supplement Plans
Because James has a Medicare Supplement, James will have an additional 365 days of “inpatient hospital benefits.” better yet, James will pay $0 for the “Additional 365 days.” There’s a notice in the summary of benefits for a Medicare Supplement plan (not to be confused with a Medicare Advantage plan) regarding when Medicare’s Lifetime Reserve Days are used. It states the following:
What a blessing that James has a Medicare Supplement! Together with his doctors, he can choose where to have his heart and lung transplants and in which skilled nursing facility he’ll recuperate. Readers who are enrolled in a Medicare Advantage plan should discuss “lifetime reserve days” with that plan’s customer service regarding extended in-patient hospital stays.
Pop quiz time!
Alice, if James’ Part D prescription drug plan doesn’t cover his new transplant prescription drugs, then who will pay?
Drum roll, please.
If you said “James will”, then you’re correct!
Please verify that his new prescriptions will be on his current Medicare Part D plan. Take your time and explore your Medicare prescription drug availability with your transplant physician’s office or transplant facility’s caseworker.
Understanding Medicare Lifetime Reserve Days: A Listicle
1. What are Lifetime Reserve Days?
Medicare Part A covers inpatient hospital stays. After the initial 60 days, you have a lifetime reserve of 60 additional days that Medicare will help pay for.
2. What happens after Lifetime Reserve Days are used?
Once these 60 days are used, your Medicare benefits for inpatient hospital stays are exhausted. This means you are responsible for all remaining costs.
3. How much does Medicare pay for inpatient hospital stays?
- Days 1-60: You pay a deductible of $1,632 (in 2024).
- Days 61-90: Medicare pays all but a daily co-payment of $408.
- Days 91 and beyond (including Lifetime Reserve Days): Medicare pays all but a daily co-payment of $816.
4. How does a Medicare Supplement Plan help?
A Medicare Supplement Plan (Medigap) can be a lifesaver in this situation. These plans typically cover the remaining costs that Medicare doesn’t pay for inpatient hospital stays, including all of the costs after Lifetime Reserve Days are used. Some plans may even cover additional days beyond the initial hospital stay.
5. What about Medicare Advantage Plans?
This information does not apply to Medicare Advantage Plans. Benefits for inpatient hospital stays may differ with these plans. Contact your plan directly to understand their specific coverage for extended stays.
6. Verifying Prescription Drug Coverage:
Make sure your current Medicare Part D plan covers any new medications needed after a hospital stay. You can’t change your Part D plan outside of the Open Enrollment Period (October 15 – December 7) unless you experience certain qualifying life events.
Call the Toni Says® Medicare hotline at 832-519-8664 or email info@tonisays.com.
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Originally published April 03, 2024
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