Inpatient Hospital Basics – Medicare Enrollment New York

Plan Medicare, is an unbiased team of local advisors in New York Medicare, offering free Medicare planning, education and enrollment for anyone turning 65 or aging into Medicare.

There are two parts of Original Medicare, Medicare Part A and Medicare Part B. Each part covers a variety of services. Today we will focus on one of the areas of coverage under Medicare Part A, inpatient hospital care.

Medicare Part A covers a variety of services including:

* In-patient hospital care
* Skilled Nursing Facility care
* Home Health Care
* And Hospice Care

In-Patient Hospital Care

Inpatient hospital care is care received after you are officially admitted into a hospital by a qualifying physician. In general hospitals, Medicare Part A will cover your stay for up to 90 days (per each benefit period), plus an additional 60 lifetime reserve days. Medicare Part A also covers up to 190 days in your lifetime and a Psychiatric Hospital that is Medicare-certified.
In order for Medicare to cover the hospital stay, the stay must be deemed medically necessary.

If you qualify for coverage under Medicare Part A, you will have all of the following services covered:
* A semi-private room and meals. (To clarify, the term “semi-private” is often used to refer to a hospital room that contains two or more beds with a curtain in between)
* General nursing support.
* Medications that are medically necessary.
* Other hospital services, supplies, and equipment.

It is important to note that Medicare Part A does not cover certain services for inpatient stays such as:
* A private room (unless medical reasons dictate otherwise, or if it is the only available option)
* Private duty nursing
* Personal care items
* Features such as a TV or phone in your room

Once you meet the Part A deductible, Original Medicare will cover 100% of your hospital stay for 60 days. On day 61 and later, there is a daily coinsurance plan. Part B also covers any outpatient services during that time period as well; however, they usually come with a 20% co-payment fee.

The Benefit Period

The benefit period is a term used to measure the length of time you receive inpatient hospital and skilled nursing facility services. The benefit period begins on the first day you are admitted to a hospital (or a skilled-nursing facility) and ends the day you leave. Original Medicare pays in full (for the services mentioned above) for days 1-60. On days 61-90, you will have a daily coinsurance. And for those who have used up all 90 days, but need to stay longer, they can use up an additional 60 days of lifetime reserve days (which do not renew with a new benefit period).
To be eligible for a new benefit period, and be eligible for Medicare Part A coverage inpatient again, you must be out of a hospital, or skilled-nursing facility for 60 days. It is also important to know that when you start a new benefit period, you also have a new Part A deductible you must meet.

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