hospital or skilled nursing facility following a hospital stay, home health care, and hospice care.
It’s important to note that Medicare has instituted benefit peri- ods. A benefit period begins the day you enter a hospital or skilled nursing facility. The period ends when you have been out of the hos- pital, or other facility, for 60 consecutive days. If you remain in a facility (other than a hospital), the period ends when you have not received any skilled care there for 60 consecutive days. Medicare places no restrictions on the number of benefit periods you can use for hospitals and skilled nursing facilities. There are, however, spe- cial limits for hospice care. No such limitations exist for home health care. These periods are used to measure your use of your benefits.
For those people needing some sort of inpatient care, hospital insurance will help pay for up to 90 days in any Medicare-participating hospital during each benefit period. Part A pays for all covered ser- vices for the first 60 days, except for a deductible amount, which you must pay. Days 61 through 90 are also paid for by Part A for covered services. However, there is a daily coinsurance amount you must pay.
Once you have been out of the hospital for 60 days in a row, any subsequent hospitalization would be subject to a new benefit period. Your 90 days of coverage would begin again, and you would again pay your deductible and any daily copayment amounts that were required.
But, what if you needed more than 90 consecutive days of hos- pitalization? Does that mean that you would have to pay for days 91 through whenever, directly out of your pocket? Not necessarily. Medicare provides for 60 reserve days over the lifetime of the recipient. Therefore, if you needed 95 days of hospitalization, the first 90 days would be covered just like any other benefit period. The last five days would require a daily copayment amount, just like days 61 through 90. Again, Medicare would pay for all cov- ered services. Once you use your 60 reserve days, though, that’s it. Medicare doesn’t issue more reserve days.
When you enter a skilled nursing facility, or if you need inpatient rehabilitation services, after a hospital stay (and you meet other certain conditions) Medicare Part A will help pay for up to 100 days, as long as you receive your care in a participating Medicare facility. As with hospi- tal stays, you have benefit periods, only here they are for 100 days, not 90.