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Limits on Hospital Stays under Medicare

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The chances that you’ll exhaust Medicare coverage during a hospital stay are remote. Still, in case you get sick enough to need a long spell in the hospital, you should know how the limits work.

Most people these days don’t spend more than a few days in the hospital, and the fear of catching a really bad hospital infection — known as a leading cause of death — is enough to make anyone want out of there as soon as possible.

If you’re enrolled in traditional Medicare

If you need to stay for a long period in the hospital for one spell of illness that’s known as a benefit period, Medicare will cover 100 percent of your nursing and living costs for the first 60 days after you’ve met a deductible. For days 61 to 90, you’re required to pay a daily co-pay.

No limit caps the number of benefit periods you can have, provided that 60 days have elapsed between each one. But if you still need to be in the hospital longer than 90 days in any one benefit period, you must either pay the full cost yourself or draw on up to 60 more days for which you pay hefty daily co-pays.

These 60 days are called lifetime reserve days. You can use as many as you want or save some in case you need them in the future. But, as the phrase implies, when you’ve used them they’re gone for good.

However, all Medigap supplemental insurance policies extend Part A hospital coverage for up to an additional 365 days after Medicare benefits are exhausted. And most Medigap policies pay for the Part A hospital deductible too. If you’re enrolled in Medicaid (state medical assistance), this program usually covers the co-pays for lifetime reserve days.

If you’re enrolled in a Medicare Advantage health plan

Medicare Advantage plans usually have a simpler system for charging for hospital stays. Often they charge a daily co-pay for the first several days and nothing for the remaining days. Most plans set no limits on the number of days they cover, so you don’t need to draw on lifetime reserve days.

But some plans do set limits, although sometimes they charge no co-pays for the lifetime reserve days. Comparing the differences between Medicare Advantage plans and traditional Medicare when it comes to hospital stays is an important topic that you will need to research carefully.

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