Hospital Stay
What Hospital Benefits Am I Entitled To?
Your Medicare Hospital coverage entitles you to 90 days of inpatient hospital care per benefit period.
What is a Benefit Period?
A benefit period starts when you enter the hospital and begin receiving a Medicare covered level of care. It ends 60 days after you stop receiving such care. If, after 60 consecutive days you again begin receiving a Medicare covered level of hospital care, a new benefit period begins. You have an unlimited number of benefit periods.
How many days of hospital coverage am I entitled to in a benefit period?
Medicare will cover up to 90 days of inpatient hospital care. Most hospital stays for Medicare patients are much shorter than 90 days. However, if you need hospital care for more than 90 days, you may draws on 60 extra reserve days. These "lifetime reserve days" are not renewable.
Do I pay any deductibles or coinsurance charges during my hospitalization?
During 1998, you must pay a deductible of $764.00 per benefit period. There are no coinsurance charges for days 1 - 60. For the 61st through the 90th day in a benefit period, your coinsurance is 1/4 of the deductible for all covered services. The coinsurance for 1998 is $191.00 per day.
The coinsurance for any lifetime reserve days taken after the 90th day of coverage is ½ of the deductible for all covered services. In 1998 the coinsurance for reserve days is $382.00 per day. These amounts change annually.
How do I qualify for Medicare in-patient hospital coverage?
In order for Medicare to pay for your care, the following conditions must be med:
The hospital participates in the Medicare program and agrees to accept you as a Medicare patient.
You require acute care, i.e., care that can only be provided in a hospital
A doctor prescribes your treatment.
You may also receive Medicare coverage immediately after receiving acute care services if you receive skilled nursing care while awaiting placement in a Skilled Nursing Facility, or "SNF."
Will all services that I receive in the hospital be covered?
Medicare will cover all hospital services except private duty nursing, a private room (unless medically necessary) or convenience items such as a telephone or television.
Does Medicare cover specialized facilities?
Medicare will cover specialized facilities such as rehabilitation hospitals and care in a psychiatric hospital subject to a lifetime limit of 190 days. (Psychiatric care received in a general hospital does not count towards this 190 day limitation.)
Does Medicare ever deny coverage of hospital stays?
Yes. Each hospital has a "utilization Review Committee (URC)" which assesses your condition to make sure you are receiving a level of care that Medicare covers. If you are not eligible, the URC will notify you.