Medicare Part A pays most of the cost of hospital stays lasting up to 60 days. But if you have a very long stay, you should expect to pay a large share of the cost.
What’s your share?
In Medicare Part A, you’ll pay a deductible for each “benefit period” (see below). You’ll also pay a daily copay after the 60th day of a long hospital stay.
How does this work?
A benefit period begins when you enter the hospital and ends when you have been out of the hospital for 60 days in a row. If you’re in and out of the hospital several times within a few weeks for the same condition, that’s still one benefit period.
In 2012, the Part A deductible is $1,156 per benefit period. In addition, if your hospital stay lasts longer than 60 days in a benefit period, you’ll pay a substantial copay for each day between days 60 and 150.
Medicare Part A limits the number of long hospital stays (stays of more than 90 days) it will pay for. When you join Part A, you’ll get a “lifetime reserve” of 60 days. Each time you stay in a hospital more than 90 days, you can use lifetime reserve days to cover the number of days you stay beyond 90.
Once you’ve used up your lifetime reserve, Part A will pay only for the first 90 days of any hospital stay. And that’s subject to the normal deductibles and copays. After 90 days, you’re responsible for paying for your own care. To see how this works, look at the examples below.
Medicare Part A also limits the number of days in a psychiatric hospital it will pay for in your lifetime.
Example: Admitted once for a brief hospital stay
| Julie spends three days in the hospital. |
|---|
| Medicare Part A deductible |
$1,156 |
| Days 1 to 3 |
$0 |
| Total Julie pays |
$1,156* |
Example: Admitted twice in a single benefit period
| Hector stayed in the hospital for 5 days in December. He was readmitted in early February and stayed for 3 days. Hector wasn't out of the hospital for 60 days before he went back to the hospital in early February, so his 8 days are all in one single benefit period. He only pays his deductible once. |
|---|
| Medicare Part A deductible |
$1,156 |
| Days 1 to 5 and 6 to 8 |
$0 |
| Total Hector pays |
$1,156* |
Example: Admitted twice in two serarate benefit periods
| Margaret stayed in the hospital 5 days in January. She was readmitted in September and stayed for 65 days. Because she was out of the hospital more than 60 days, her second stay began a new benefit period. |
|---|
| Medicare Part A deductible 1 (January) |
$1,156 |
| Days 1 to 5 |
$0 |
| Medicare Part A deductible 2 (September) |
$1,156 |
| Days 1 to 60 |
$0 |
| Days 61 to 65 (5 days at $289 each) |
$1,445 |
| Total Margaret pays |
$3,757* |
Example: Admitted for a long hospital stay
| Juan stayed in the hospital 185 days before his doctors felt they could release him. Part A stops paying for Juan's care after day 150. Juan has used up all his lifetime reserve days, and he has no Part A coverage left. The hospital's charges for the days 151 to 185 are $1,200 per day. |
|---|
| Medicare Part A deductible |
$1,156 |
| Days 0 to 60 |
$0 |
| Days 61 to 90 (30 days at $289 each) |
$8,670 |
| Days 91 to 150 (60 days at $578 each) |
$34,680 |
| Days 151 to 180 (35 days at $1,200 each) |
$42,000 |
| Total Juan pays |
$86,506* |
* These exampls show hospital charges only. There may be additional cost sharing for services such as physicians, labratory, and radiology.