How Many Days Does Medicare Cover for Long-Term Acute Care?
Medicare has coverage for different types of hospitals, including long-term acute care hospitals (LTACHs). These specialized facilities provide more intensive care for people with complex conditions, who need oversight and treatment for longer periods of time.
Medicare Part A, which is your hospital insurance, covers stays at an LTACH. Your out-of-pocket costs depend on how long you stay at an LTACH. We’ll go over the number of days Medicare covers for long-term acute care and more in this article.
Key takeaways:
Medicare covers 90 days for long-term acute care.
If you have lifetime reserve days, Medicare will cover up to 60 extra days depending on how many days you have left.
Your out-of-pocket costs for long-term acute care depends on how long you stay at the hospital. It includes a Part A deductible of $1,632, plus extra costs beyond 60 days.
Medicare Advantage plans handle hospital insurance differently than Original Medicare, and you’ll need to consult your summary of benefits to understand how your plan’s LTACH coverage works.
What is a long-term acute care hospital (LTACH)?
An LTACH, or long-term acute care hospital, is a specialized healthcare facility for extended medical care. LTACHs provide a high level of treatment and management needed to care for people recovering from serious conditions. Patients often stay at an LTACH for 20 to 30 days or longer. Unlike regular hospitals or skilled nursing facilities, LTACHs are equipped with advanced medical technology and a wide range of healthcare providers for comprehensive, long-term care.
What types of conditions are treated at LTACHs?
Medical conditions treated at LTACHs are often serious. Many times patients are relocated from an ICU at a regular hospital to an LTACH for long-term care. In some cases, long-term acute care hospitals treat more than one complex condition.
Common conditions include:
Respiratory failure
Severe infections
Complex wounds from surgery or ulcers
Stroke recovery, brain injury, and other neurological conditions
Heart failure and other cardiac conditions
Organ failure
Chronic renal failure
Trauma-related conditions
Cancer-related complications
Does Medicare cover LTACH care?
Medicare covers long-term acute care hospital stays under Part A. The cost you owe out of pocket for an LTACH visit depends on how long you stay. For the first 60 days, you pay all hospital costs until you reach the Part A deductible of $1,632. You won’t have to pay more than that during these first 60 days. After that, you’ll have different out-of-pocket costs. Here’s a breakdown of all your costs:
Days 1-60: $1,632 deductible
Days 61-90: $408 per day
Days 91 and beyond: $816 per day while using your lifetime reserve days
You’re responsible for all LTACH costs for every day after your 60 lifetime reserve days are used
What if you’ve already paid the Part A deductible?
If you’ve already paid your Part A deductible before you visit an LTACH for long-term care, you may be wondering if you still have to pay the $1,632. That depends on whether or not you’re in the same benefit period. Unlike Part B (which has a yearly deductible), you have to pay a Part A deductible for each inpatient hospital benefit period.
A benefit period starts the day you’re admitted to a hospital and ends 60 days after you’re discharged.
That means that if you’re transferred from another hospital and you’ve already paid your deductible, you won’t have to pay it again. Similarly, if you’re admitted to an LTACH within 60 days after another hospital stay, you won’t have to pay your Part A deductible again.
However, you will have to pay the deductible again if you enter a new benefit period. For example, if you needed treatment at a hospital, were discharged in January, and paid your Part A deductible, you’ll have to pay it again if you stay at an LTACH (or other hospital) in May.
How many days does Medicare cover for long-term acute care?
Medicare covers 90 standard days for long-term acute care at a hospital. However, you’ll have varying out-of-pocket costs depending on the number of days you’ve stayed. If you have additional lifetime reserve days, Medicare will also cover some costs until you use them all.
Staying at an LTACH can be expensive, but a Medicare Supplement plan can help you cover some of your out-of-pocket costs. Most Medicare Supplement plans cover the Part A deductible, and all plans cover Part A coinsurance and hospital costs up to 365 days after your Original Medicare benefits are used. If you need long-term acute care, it will be incredibly beneficial to have a Medigap plan. There’s no maximum to the number of benefit periods in one year, so you could end up paying a lot of money without a Medigap plan.
Your out-of-pocket costs could be higher with a Medicare Advantage plan since they have varying copays, deductibles, and coinsurance amounts. Make sure you read your plan details about hospital coverage carefully, and contact your insurance provider with any questions.
Help from a Medicare Advisor at Chapter
We’re here to simplify your Medicare journey, so you can focus on the things that matter most. If you have any questions about long-term acute care, Medicare Part A, or Medicare Supplement plans, we’d be glad to help. Get in touch with us at 855-900-2427 or schedule a time to chat to get help.