If you have Medicare, you should be up-to-date of the prospective costs of a hospital stay so that you can plan accordingly. While Medicare Part A normally covers hospital stays, including your room, nursing services, meals, medications, and so on, it only does so for 90 days. So, what if you need to be in the hospital for a longer period of time? This is when lifetime reserve days come into play. Lifetime reserve days are the number of hospital days that an insurance policy will cover beyond the number of days given per benefit period. However, be careful, you only get 60 of these extra days.
How Lifetime Reserve Days Work
Lifetime reserve days are one of many Medicare rules. Your benefit period begins when you enter a medical facility, such as a hospital, and continues until you are discharged from the facility and go 60 days without reentering the hospital. If you have to stay longer than the days provided per benefit period, you can use your lifetime reserve days to do so. For example, assume you have a 100-day hospital stay. The first 60 days are totally covered by Medicare. Days 61 through 90 will have a copay, while the remaining days will be covered by 10 reserve days. However, you will also have to pay a coinsurance for these reserve days, which will be $816 a day in 2024.
That is just an example though you don’t have to use them in this way. In fact, you are free to use these reserve days as you see fit. There are no guidelines for dividing the days. You are not forced to use these days, and you can choose to pay for your additional hospital days out of pocket. When you get close to your 90-day threshold, the hospital will notify you so you can let them know if you want to use your reserve days and how many. You can also change your mind about using your reserve days after you leave the hospital. You have 90 days from the date of discharge to provide the hospital written notice. They will then just bill you for the outstanding sum, and your reserve days will be reinstated.
What Do The Lifetime Reserve Days Cover?
Medicare pays all covered costs, minus your daily coinsurance, for each lifetime reserve day used during a hospital stay. Some of the expenses covered by Part A if you are admitted for inpatient care at a hospital that accepts Medicare. Which includes semi-private rooms, meals, general nursing, and medications for inpatient therapy. If you require care that is not covered by Part A, such as a private room or a private-duty nurse, you have to cover the additional costs on your own.
Medicare Rules
To use a lifetime reserve day, you must first be eligible for Medicare Part A inpatient hospital care. Your hospital status (whether you are an “inpatient” or “outpatient”) influences how much you pay for hospital services (such as X-rays, medications, and lab testing). The choice to admit you to an inpatient hospital is a difficult medical decision based on your doctor’s recommendation and your need for medically necessary hospital treatment. When you are expected to need two or more “midnights”, meaning you stay past midnight, of medically necessary hospital care, an inpatient admission is generally eligible for payment under Medicare Part A (Hospital Insurance), but your doctor must order this admission and the hospital must formally admit you for you to become an inpatient. In order to use a Medicare lifetime reserve day, you must also use Medicare Part A hospital inpatient services for more than 90 days in a benefit period.
As far as cost goes, lifetime reserve days aren’t free. Original Medicare imposes varying co-pays based on the number of days you remain in the hospital, with lifetime reserve days beginning after day ninety. The first sixty days of a hospital stay are free of charge, days 61 to 90 have a daily co-pay of $408 (in 2024), and days over 90 have a $816 co-insurance per lifetime reserve day used.
Your Part A daily lifetime reserve day co-insurance might be covered by a Medicare Supplement insurance coverage. Part A inpatient hospital care co-insurance is covered in full by all Medicare Supplement Plans. If you get eligible Part A hospital inpatient care and need to take advantage of a lifetime reserve day, your Medicare Supplement coverage will cover the daily co-insurance. These plans will also cover up to an additional 365 days in the hospital. Although private insurance companies provide the coverage, the federal government requires that the policies be standardized. Which means no matter where you buy a policy from every plan of the same letter will have the same benefits.
Plans A, B, C, D, F, G, and N all cover 100% of your Medicare Part A hospital cost and coinsurance as well as 100% of your Part A deductible.
Plans K and M will cover 100% of Part A’s coinsurance and 50% of your part A deductible.
Finally Plan L will cover 100% of your Part A coinsurance and 75% of your Part A Deductible.
It’s important to note that Plan C and Plan F are no longer available to new Medicare enrollees. It is still available to those who were eligible for Medicare before January 2020.
Medicare Supplement Plan A only covers the minimal benefits that are needed of all Medicare Supplement Plans. That means this plan is a wonderful option for people looking for a low-cost plan that will still help lower Original Medicare expenses, such as the 20% Part B coinsurance, which can quickly pile up. Plan A further lowers out-of-pocket expenditures by having a yearly out-of-pocket maximum, which Original Medicare does not have. It also covers:
Plan B includes all of the essential benefits of Plan A, as well as some of the added benefits provided by other Medicare Supplement Plans. Although Plan B is not the most comprehensive Medicare Supplement Plan available, it is an excellent choice for those seeking additional coverage for out-of-pocket expenses. Plan B includes:
Anyone who was qualified for Original Medicare before January 1, 2020, is eligible to enroll in Plan C. If you were not Medicare-eligible at the time, you cannot enroll in Plan C. Medicare Supplement Plan C compensates for any Medicare-approved expenses not covered by Original Medicare. This covers, among other things, annual deductibles, copays, and coinsurance. It covers:
Plan F has long been the best-selling plan on the market. It covers all of your out-of-pocket payments, so if you have this plan, you’ll just have to pay the monthly Plan F premium. The only restriction is that, like Plan C, Plan F is not available to anyone who became Medicare eligible after 2020. If you were eligible for Medicare before 2020, you can purchase one of these plans; if you had purchased Plan F and are grandfathered in, you can keep it indefinitely. It includes:
Plan G is the most comprehensive Medicare Supplement Plan accessible to new Medicare beneficiaries. Since the ending of Plan F, this plan has gained in popularity and has become one of the most popular Medicare Supplement Plans available today, if not the most popular. Plan G bridges the gap between what Original Medicare covers and the charges that you have to pay in an extremely cost-effective manner. It includes:
Plan K is a fantastic solution for decreasing your cost-sharing requirements when combined with Original Medicare. This plan, like all Medicare Supplement Plans, seeks to pay some of the expenditures that Original Medicare does not cover, although to varying degrees. It includes:
Plan L, like Plan K, is a supplemental healthcare plan that includes cost-sharing benefits. In addition to the monthly premium for your policy, you will be responsible for deductibles, coinsurance, and copayments with Plan L. However, your plan will have a maximum out-of-pocket limit. It covers:
Plan M is an excellent option for consumers who want to keep their monthly costs low. Its coverage helps with many out-of-pocket expenditures that Original Medicare does not cover, such as copayments, coinsurance, international travel emergency care, and your first three pints of blood. It addresses:
Along with Original Medicare coverage, Plan N offers complete benefits. You will only be liable for your Medicare Part B deductible, minor copays at the doctor’s office, and excess charges if applicable in your situation if you choose this plan. Plan N includes:
Medicare Part A coinsurance and hospital cost
Medicare Part B coinsurance or copayment
First 3 pints of blood
Part A hospice care or coinsurance
Skilled nursing facility coinsurance
Medicare Part A deductible
80% of foreign travel emergency
Need Some Help?
Lifetime reserve days are an effective tool. If you plan ahead of time, you can reduce your out-of-pocket expenses and focus solely on getting better. However, if you believe you will want additional coverage for hospital stays, a Medicare Supplement Plan can help. After you’ve used all your lifetime reserve days, all Medicare Supplement Plans provide an additional 365 days of hospital care.
If you have any concerns or need assistance in locating a Medicare Supplement Plan, EZ.Insure can assist you. Our knowledgeable agents collaborate with the best companies in the country, making it simple for you to find what you require. Simply enter your zip code into the area below to receive your free, no-obligation quote. If you’d rather chat with an agent directly, call 877-670-3602.
After retirement, some seniors decide to embark on a new challenge: moving. You may want to relocate to a warmer place that is more “senior friendly.” A lot goes into planning when moving, and it can be quite chaotic. One major need is your Medicare coverage. You must notify your Medicare plan providers that you are moving, and then make sure your future doctors in the new state participate with Medicare. Make sure the Social Security Administration is updated as well. Aside from this, it is super important to know that if you are enrolled in a Medicare Supplement plan, your policy price may change depending on where you move to. Do not get stuck with extra charges. Make sure to get it all situated before the move.
When you are moving across states lines, it is important to make sure your Medicare plan is updated.
Original Medicare
Medicare is a federal program and does not change no matter where you move to in America. Medicare Parts A and B do not change. Just make sure before you move, research to find doctors who accept Medicare in the new state.
Medicare Advantage
Medicare Advantage plans have networks depending on the state’s county you live in. You will need to change your Medicare Advantage plan. These plans assign specific doctors through their HMO or PPO plans, so you will have to choose a new plan and a new Primary Care Provider within the plan’s network. Some areas do not even offer Medicare Advantage plans. Notify your current plan before moving.
Medicare Supplement
Medicare Supplement plans help pay for the remaining 20% of the Medicare Part B costs. The plan’s price is determined by your zip code because it varies from state to state. In most states, you can keep your Medicare Supplement plan when you move, but you can apply for a different one if you want. Although you can remain on the same plan, your fees may go up (or down) depending on where you go.
If you do decide to change to a different plan, you might have to go through a health exam, also known as medical underwriting, and the plan may not accept your application. After you are accepted into the new Medicare Supplement plan, you have a “free look period” for 30 days to stay with the new plan. You will, however, have to pay for both plans during the 30-day period. If you decide to keep the new plan, then you can call your old plan and ask
If you are stressed out, or do not know where to start, then get help from a Medicare agent.
for your coverage to be over.
If your Medicare Supplement plan increases when you move to a new state, then you can always contact a Medicare agent to help you search for a more affordable plan. EZ.Insure offers Medicare agents that are trained in your area, and within the state you are moving to. Your personalized Medicare agent will go over your current Medicare Supplement plan to make sure it will be a good fit for you in the new state. If it will be too costly, then our agent will go over all the plans within the new state, compare them, and provide you with quotes. There is no hassle and no obligation. To get started, you can enter your zip code in the bar above, or speak to an agent directly by emailing Replies@Ez.Insure or calling 855-220-1144. We promise to help you find, and sign up with the best Medicare Supplement plan that meets all of your needs within your budget.
Medical underwriting is a process when a private insurance company reviews your medical history to determine whether they will provide you with coverage, how much to charge you, and whether to set a waiting period before coverage begins. If you have a lot of medical issues, you may have to pay more for coverage or even be denied approval. Pre-existing conditions will come up and can cost you greatly.
After your Medicare underwriting is complete, companies decide whether to accept you, or deny you coverage due to your pre-existing conditions.
Medicare Supplement plans help pay for out of pocket expenses such as copays, coinsurance, and deductibles. When
you sign up for a Medicare Supplement plan, you may need to go through the underwriting process. It all depends on when you decide to sign up for a supplement plan. To answer the question if Medicare underwriting is necessary, both yes and no. Find out how to avoid Medicare underwriting, and if you do have to go through it, then what it entails.
The Only Time To Avoid Medicare Underwriting
During the Medicare Supplement Open Enrollment Period is when you have “guaranteed issue rights.” Guaranteed issue means that you will be accepted into any plan regardless of your health condition or pre-existing conditions. During this time, you have a one-time guarantee when companies cannot deny you or charge you more due to a pre-existing condition. The Medicare Supplement Open Enrollment Period is a six month period that begins the first day of the month you turn 65 years old, and enrolled in Medicare Part B.
When You Need To Be Underwritten
If you apply for a Medicare Supplement plan after your Medicare Open Enrollment Period has passed, then you may have to go through the underwriting process. In addition, when you are switching Medicare Supplement plans, you may have to go through the underwriting process. If a Medicare Supplement plan accepts your application, the insurer can choose to make you wait 6 months before covering a pre-existing condition. This is known as a “look-back period,” or “pre-existing wait period.”
The Underwriting Process
Private insurance companies will have extensive health-related questions on their applications. It will go over your entire medical history, both past and present. If you have a pre-existing health condition that may be expensive for the company to cover, they can choose to deny your application.
During the Medicare underwriting process, companies will go through your medical history and check off which conditions may be considered an expensive health risk for them to cover.
If you have a health condition that needs constant attention, chronic, or incurable, then you may be denied. Certain medications can also be a reason for denial, especially for the incurable or chronic health conditions, simply because it will be too expensive for the insurers to cover. Often times minor conditions such as BMI, high blood pressure, and cholesterol are not issues for carriers. If you have pending surgeries or treatments, then it is best to get them done before applying. Serious health conditions such as rheumatoid arthritis, dementia, chronic lung disorders, lupus, MS, major heart disorders, and kidney failure will be an automatic denial of coverage for the company.
If you are still within your Medicare Supplement Plan Open Enrollment Period, then great, no better time to get started and sign up for a plan. If you have passed this guaranteed issue window, you can still apply with caution. And if you get denied, then it is not the end of the world, our agents will search through all available Medicare Supplement plans and help you.
EZ.Insure has highly trained agents who will search through all the Medicare Supplement carriers in your region, whether you are within the open enrollment period or not. Your personalized agent will compare all the plans, their coverage, and their quotes. To get started, you can enter your zip code in the bar above, or speak to an agent directly by emailing Replies@Ez.Insure or calling 855-220-1144. We will be by your side throughout the process, walking you through it, while providing you with the best advice and options.
