Opinion - Ins and Outs of Medicare's "Lifetime Reserve Days"

Toni Says


Toni: 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 congested heart failure only to discover that his heart and lungs can no longer support him. The wait on his double transplant is taking longer than expected and 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, TX Anna: The hospital staff had Greg sign the form about the “lifetime reserve days” because once he is past the Inpatient Hospitalization 60 Lifetime Reserve days, then Medicare stops paying and the stay is his responsibility. Anna, there is a notice written in the summary of benefits for a Medicare Supplement plan only and not a Medicare Advantage plan regarding once Medicare’s Lifetime Reserve Days are use and it 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.”

For 2022, Medicare Part A covers an inpatient hospital stay with a $1,556 deductible for days 1-60. Yes, an Inpatient hospital deductible of $1,556 can happen 6 times a year. This includes 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 with the 60 “lifetime reserve days” to be used. Once the Medicare lifetime reserve days are used, there are not anymore “inpatient hospital benefits.”

You will pay all the cost of the remainder hospital stay. Since Greg has a Medicare Supplement, he will have the additional 365 days of “inpatient hospital benefits” that only a Medicare Supplement insurance plan has and will pay. What a blessing that Greg has a Medicare Supplement and he and his doctors together can pick how and where to have his heart and lung transplants and which rehab/ skilled facility he will select while recuperating.

Those enrolled in a Medicare Advantage plan should discuss “Lifetime Reserve Days” with that plan’s customer service regarding extended in-patient hospital stays. If your Part D plan does not cover your new transplant prescription rugs, then who will pay…. You will! Please 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 Toni Says® Medicare consultation, we are specific about personalizing your Medicare Part D planning because once enrolled you cannot change until the Medicare Annual Enrollment Period which is October 15th to December 7th. Toni Says Webinar series is available at www.tonisays.com with an additional video regarding “How to find the Right Prescription Drug Plan.”

For assistance with enrolling and personalizing your Medicare contact the Toni Says® office at 832/519-8664 or email your Medicare question to info@tonisays.com. Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the 2022 Medicare Survival Guide® Advanced book atwww.tonisays.com.