Will my mother be covered by Medicare for one day stay in hospital?

1 answer | Last updated: Sep 21, 2009
A fellow caregiver asked...

Will my mother be covered by Medicare for one day stay in hospital? My mother suffers from osteoarthritis and was recently in a rehab center following a medical procedure to repair a fracture in the L5 vertebrae and pelvis. She was released after 20 days (we were led to believe she was in a better condition than she actually was). The day she was released she fell at home, which resulted in her breaking both legs. Will Medicare cover the rehab of this injury considering my mother had only been discharged for one day? The hospital states Medicare will not cover it because it had not been 60 days between visits.

Expert Answers

Sounds like someone at the hospital or rehab center is misinterpreting the rules about Medicare Part A hospital coverage. Whether Medicare Part A pays for your mother’s hospital or rehab center stay, and how much it pays, is measured by what's called a "benefit period" or "spell of illness." This is the period during which your mother is a hospital inpatient. The benefit period begins the first day in the hospital and continues until your mother has been out of the hospital and Medicare-covered rehab center for 60 consecutive days. If she goes back into the hospital before the 60 consecutive days are up, Medicare considers her new hospital stay to be a continuation of the previous stay and charges her copayments based on the following schedule.

For any one benefit period, your mother pays a hospital deductible of $1,024. 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, your mother must pay a coinsurance of $256 per day for days 61 to 90, with Part A paying the rest. These payment periods are renewed for each new benefit period. If a hospitalization or series of hospitalizations within one benefit period lasts more than 90 days, your mother must pay $512 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 any patient's lifetime. Once they're used up, your mother would be responsible for the full cost of any hospital stay beyond 90 days in any benefit period. So, if your mother was in the hospital and rehab center combined for less than 150 days total in this one benefit period, Medicare Part A will cover her costs for her new hospitalization except for her deductible, and except for her copayments for days 61 through 150.