Benefit period
The amount Part A pays is measured by what's called a "benefit period" or "spell of illness." This is the time period during which a patient is a hospital inpatient for a particular illness or injury, plus the following recovery time in a nursing facility or with home care. The benefit period begins the first day in the hospital and continues until he or she has been out of the hospital for 60 consecutive days.
For any benefit period, patients pay a hospital deductible of $1,156 (in 2012). After that, Part A pays 100 percent of covered care for the first 60 days in the hospital. If a hospitalization lasts more than 60 days in a single benefit period, participants must pay $289 per day for days 61 to 90, with Part A paying the rest. These payment periods are renewed for each new benefit period during a participant's lifetime.
If a hospitalization lasts more than 90 days, participants must pay $578 a day, with Part A paying the rest, for up to 150 days. Days 91 to 150 are known as "reserve days." There are only 60 reserve days in a patient's lifetime. Once they're used up, participants are responsible for the full cost of any hospital stay beyond 90 days in any benefit period.
In any benefit period, Part A covers up to 100 days of skilled nursing facility care. For the first 20 days, Part A pays the full cost. For the next 80 days, participants are responsible for a co-payment of $144.50 per day. Various forms of dementia are common among the elderly, so it's possible that someone in your care might need a stay in a psychiatric facility even if he or she has no history of mental or emotional illness. If so, Part A covers the full amount of the charges for that stay, minus only the hospital deductible.
Hospice
Part A pays 100 percent of the cost of hospice care, except for a $5 per prescription co-payment for prescription drugs, plus a 5 percent charge for any time partients need to receive hospice care as an inpatient in a nursing or hospice facility.
Home care
For home care, Part A pays 100 percent of the agency's charges, except for durable medical equipment -- like rental of a wheelchair or hospital bed -- provided by the home care agency, for which Part A pays 80 percent.
Very helpful.Thanks.
Hi adsg, That's a good question. While I don't have the answer, you can post your question to our Ask & Answer section, here: ( http://www.caring.com/ask ). I hope that helps! -- Emily
My mother-in-law is in a skilled nursing facility and her 100 days is about to expire. She still needs PT, 24/7 oxygen, breathing medicine and treatments. I know Medicare will pay again after 60 days - but someone said she had to be out of that facility for 60 days then she could go back. Is this true? Or, could we pay for the 60 days and then Medicare pick back up? Anyone know ?????
my 94 year old Grandmother has Medicare as her primary and Tricare as her secondary, so I believe we are good to go, haven't seen any bills from home health care or hospitals, should I be checking????
Very informative; clear and concise.
Very informative article; simple and clear.
clearly explained.
A very informative article....much appreciated.