Each time a patient admits to an Acute Care Hospital, Medicare starts counting days. Long Term Acute Care Hospitals (Noland Hospitals) use the same bank of days as Short Term Acute Care Hospitals.
The first 60 days (day 1-60 of the hospital stay) Medicare pays 100% after the $1,260.00 deductible is met. Many times the patient’s secondary insurance will pay the deductible; otherwise, it is the patient’s responsibility to pay the deductible. Usually the deductible is exhausted in the Short Term Acute Care Hospital.
The next 30 days (days 61-90 of hospital stay) are called co pay days. Medicare should pay the entire allowable amount except for the co-insurance amount of $315.00 per day. Many times the secondary insurance will pay the co-insurance. Otherwise the $315.00 per day is the patient’s responsibility.
The next 60 days (days 91-150 of the hospital stay) are called lifetime reserve days, often referred to as “LTR”. Medicare again will pay the entire allowable amount except the co-insurance of $630.00 per day. Many times the secondary insurance company will pay the co-insurance. Otherwise the $630.00 per day is the patient’s responsibility.
Once the patient experiences a 60-day wellness period, he or she will regain all Medicare days. A 60-day wellness period is defined as 60 consecutive days outside of a hospital, inpatient rehab facility, or skilled nursing facility. However, all Medicare days will count against the patient’s lifetime reserve (LTR) days. Once exhausted, LTR days are never regained.
**Skilled nursing days are not the same as hospital days. Skilled nursing days are used once a patient is discharged to a Skilled Nursing Facility (SNF) from a hospital or other setting, such as Acute Rehab. Generally speaking, the Medicare benefit for SNF is 20 full days and 80 co pay days, for a total of 100 skilled nursing days.**