Can you explain why a hospital employee from the medical claims division asked my husband Greg to sign a form stating that he is aware that he is now in his “Lifetime Reserve Days” while he is waiting for his lung/heart double transplant?
He went in the hospital in May for congestive heart failure only to discover that his heart and lungs can no longer support him. The wait for his double transplant is taking longer than expected. I am concerned that the hospital will send him home or to a nursing home to wait and he will not receive the correct medical care.
Please explain what Greg needs to do. He is covered by a Medicare Supplement, and he has had no issues with that plan.
-Thanks, Anna from Conroe, Texas
The hospital staff had Greg sign the form about the “lifetime reserve days” because once he is past the initial 90 days covered per benefit period and has used his Inpatient Hospitalization 60 Lifetime Reserve days, then Medicare stops paying and the stay is his responsibility.
For 2022, Medicare Part A covers an inpatient hospital stay with a total deductible of $1,556 for days 1-60. (And yes, an inpatient hospital deductible of $1,556 can happen 6 times a year.) Medicare Part A will cover a semiprivate room and board, general nursing and miscellaneous services and supplies.
If your Part A-Inpatient Hospital stay is longer than 60 days, then for days 61 thru 90 Medicare pays all but $389 per day; and for days 91 and after, Medicare will pay all but $778 per day for up to 60 “lifetime reserve days.” These days do not re-set. If your stay is 95 days, then you will have 55 lifetime reserve days left. Once all 60 Medicare lifetime reserve days are used, there are not any more “inpatient hospital benefits.” You will pay all costs of the remainder of the hospital stay.
There is a notice in the summary of benefits for a Medicare Supplement plan only, and not a Medicare Advantage plan, regarding Medicare’s Lifetime Reserve Days. The notice states: “**NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy’s ‘Core Benefits.’ During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.”
Since he has a Medicare Supplement, Greg will have the additional 365 days of “inpatient hospital benefits” that only a Medicare Supplement insurance plan will pay. What a blessing that Greg has a Medicare Supplement so he and his doctors together can pick how and where to have his heart/lung transplant and which rehab/skilled facility he will select for recuperating.
Follow trends affecting the local economy
Subscribe to our free Business by the Bay newsletter
You’re all signed up!
Want more of our free, weekly newsletters in your inbox? Let’s get started.Explore all your options
Those enrolled in a Medicare Advantage plan should discuss “Lifetime Reserve Days” with that plan’s customer service representatives regarding extended in-patient hospital stays.
And if your Part D plan does not cover your new transplant prescription drugs, then who will pay? You will! Verify that your new prescriptions will be on your 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.
During a Medicare consultation, we at Toni Says are careful about personalizing your Medicare Part D planning because, once enrolled, you cannot change plans until the Medicare Annual Enrollment Period which is October 15th to December 7th.
Toni King is an author and columnist on Medicare and health insurance issues. She spent more than 27 years as a top sales leader in the fields. For answers to Medicare questions, email: firstname.lastname@example.org or call 832-519-8664.