How long will MA pay for continous stay in hospital.?

[rmhaire]

Im not sure but they say they cover an unlimited amount of days.

I know. That's exactly what mine shows and still doesn't answer the question.

Here's my problem. MA plans are simply parts A + B = C and sometimes D.

Hospital stays are mostly paid by part A and Medicare is very specific:

90 day benefit period in hospital. Must stay out of the hospital for 60 days before a new benefit period can begin. No limit to the 90 benefit periods per year or lifetime. The tricky part is the 60 day stay your ass at home part.

Again, what I just posted is Medicare. Forget about Supps and MA plans.

What company is going to keep on going like the energizer bunny after 90 + 60 days?

 

[axeman462]

Ok MA experts how long will MA pay for continous stay in hospital.
I KNOW Original Medicare pays 90 days plus 60 days of lifetime reserve . I've seen this probably 10 times with my clients on OM with supp . Never a problem.
Now I'm trying to get the quick Cliff Notes for a sister-in-law on a MA.

in florida, most, if not all plans are unlimited. not sure if that true in other states

 

[DonP]

So the question really is what mapd company will allow anyone to stay in the hospital 200 plus days? They,ll deny the claim and tell the hospital their no longer paying

 

[Chazm]

I know. That's exactly what mine shows and still doesn't answer the question.

Here's my problem. MA plans are simply parts A + B = C and sometimes D.

Hospital stays are mostly paid by part A and Medicare is very specific:

90 day benefit period in hospital. Must stay out of the hospital for 60 days before a new benefit period can begin. No limit to the 90 benefit periods per year or lifetime. The tricky part is the 60 day stay your ass at home part.

Again, what I just posted is Medicare. Forget about Supps and MA plans.

What company is going to keep on going like the energizer bunny after 90 + 60 days?

Always check the EOB. According to UHC each hospital admittance is a new benefit period. For this plan in particular, up to the $2,900 MOOP.
This plan will cover unlimited days for a hospital stay. Period. For each admission you pay the copay.

 

[rmhaire]

Always check the EOB. According to UHC each hospital admittance is a new benefit period. For this plan in particular, up to the $2,900 MOOP.
This plan will cover unlimited days for a hospital stay. Period. For each admission you pay the copay.

I agree. And I always do.

But when I see a gray area I always go the the Bible. And that's Medicare itself. Not MAs, not Supps and not Carriers.

 

[Cdevin]

It isn't what the terms say. It is all based on algorithms, if said plan algorithm says you can stay X amount of days based on your health profile, then they will stop paying after X day. The terms say unlimited days per year, which resets every year. But ain't a snowball chance in hell a company will pay for that. They will pay, then stop paying. You can likely get it reimbursed since the algorithm is frequently wrong, but it stops paying automatically based on your profile. That is one of the biggest things with advantage plans, the middle man. If a plan stops paying, you are usually not in the shape to argue with the insurance companies algorithm which is what they bank on.

 

[rmhaire]

It is all based on algorithms

Thank God.

I've been looking for him since high school. Al Gorithm

 

[somarco]

Extremely long hospital stays are a rarity . . . many times the patient is transferred to a SNF or rehab center.

However, I had a client with a rare form of adrenal cancer who spent the last 4 years of her life in various hospitals . . . Atlanta, Baltimore and finally Dallas. She was on a KP Obamacare plan prior to T65, then on Medicare + Medigap.

Her Anthem Medigap paid as follows . . .
Once lifetime reserve days are used:

Additional 365 days: Medicare pays $0, Plan pays 100% of Medicare eligible expenses, you pay $0.
NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid for up to an additional 365 days as provided in the policy's "Core Benefits." During this time the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid."




I assume other carriers would work in the same manner

Would any MA plan cover an extended stay like this?

 

[Millwood]

It isn't what the terms say. It is all based on algorithms, if said plan algorithm says you can stay X amount of days based on your health profile, then they will stop paying after X day. The terms say unlimited days per year, which resets every year. But ain't a snowball chance in hell a company will pay for that. They will pay, then stop paying. You can likely get it reimbursed since the algorithm is frequently wrong, but it stops paying automatically based on your profile. That is one of the biggest things with advantage plans, the middle man. If a plan stops paying, you are usually not in the shape to argue with the insurance companies algorithm which is what they bank on.

 

[Millwood]

FIRST thanks to all who gave me insight. It's all fun and games till it's family. This....... had a long talk with Doctor.
On what to expect. Said it would be a battle to keep her in hospital. SIL fell on coffee table punctured lung with broken rib. Didn't go to Dr. and was admitted to ER a week later severe blood infection by then. They put her on Ventilator and induced coma so she doesn't fight it. 60 days so far. Have pulled off ventilator 2x and took off IV to induce coma but infection keeps coming back. Doctor said she'll probably go to a long term hospital where most are there for chronic infection or on ventilators.