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How do Medicare’s lifetime reserve days work?

Dear Toni: Why did a hospital medical claims division employee ask my husband, James, to sign a form stating that he is aware that he is now in his “lifetime reserve days” while he was waiting for his lung/heart transplant?

He went into the hospital in December for congestive heart failure, only to discover that his heart and lungs can no longer support him. The wait for this double transplant is taking longer than expected. 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 James needs to do. He is covered by a Medicare supplement Plan G, and he has had no issues with that plan. — Alice, Atlanta

Dear Alice: The hospital staff had James sign the form regarding lifetime reserve days because once he is past that 60- day period of inpatient hospitalization Medicare stops paying and the stay is his responsibility.

For 2024, Medicare Part A covers an inpatient hospital stay with a $1,632 deductible for days 1 through 60. (An inpatient hospital deductible of $1,632 can happen six times a year.) This includes a semiprivate room and board, general nursing and miscellaneous services and supplies.

For days 61 through 90, Medicare would pay all but $408 per day.

After that, the lifetime reserve days begin. For days 91 and beyond, Medicare will pay all but $816 per day. Once the reserve days are used, then the inpatient hospital benefits are exhausted and you will pay all costs for the remainder of the hospital stay.

The good news for James: His Medicare supplement will cover an additional 365 days of inpatient hospital benefits once his Part A benefits are exhausted. He will pay $0 for the additional 365 days (except for his annual deductible in the new year).

Readers enrolled in Medicare Advantage plans should discuss lifetime reserve days with a customer service agent for their plan.

Another important note about James’ situation: If his Part D prescription drug plan does not cover his new transplant drugs, then he will end up paying for them. Alice, verify that his new prescriptions will be on his current Part D plan, and explore prescription drug availability with the transplant physician’s office or transplant facility’s caseworker.

Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.

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