Hospital deductibles calculated by benefit period Covering The Bases

I was admitted to the hospital for three days in early January. I paid my inpatient deductible of $1,288. I had to be readmitted to the hospital last month. I was shocked to be billed another deductible of $1,288. I've already paid for the year, so why am I being charged a second deductible?

Medicare's Part A (hospital) deductible is calculated per benefit period rather than per calendar year. A benefit period begins the day you are admitted into the hospital. The benefit period ends when you have not received any inpatient hospital care (or inpatient skilled nursing facility care) for 60 days in a row.

Your first benefit period ended 60 days after your discharge from the hospital. Your second hospital admission began a new Medicare Part A benefit period and generated a new Medicare Part A deductible.

My only daughter is moving across country. I live alone and don't want to burden her as I grow older. Will Medicare pay for me to live in an assisted living home or nursing home? If not, is there insurance I could purchase for this type of care?

Medicare does not pay for assisted living facility care or long-term care in a nursing home. Since Medicare will pay for skilled care in a skilled nursing facility, many people mistakenly believe Medicare pays for long-term care.

There are strict rules as to when Medicare will pay for skilled care in a skilled nursing facility. To trigger the Medicare skilled nursing benefit, the client must have a qualifying inpatient hospital admission. The hospital stay must be for at least three consecutive days (not counting the day of discharge). The patient must require skilled services (such as physical therapy) and these skilled services must be reasonable and necessary for the client's diagnosed condition. The skilled care must be ordered by a physician. The client must require the skilled care on a daily basis and such care can only be provided in an inpatient skilled nursing facility. The maximum that Medicare will pay for a skilled care, per benefit period, is 100 days.

For care in an assisted living facility or for long term-care in other settings, some people consider a long-term care insurance policy. The booklet, "A Shoppers Guide to Long-Term Care Insurance," explains this type of insurance. This booklet is published by the National Association of Insurance Commissioners. You may request a copy by email at [email protected] or by calling 1-816-783-8300 or by downloading it (visit www.naic.org and enter "A Shoppers Guide to Long-Term Care Insurance" in the search box).

I heard that pharmaceutical companies may provide help with the cost of their medicines. I did an internet search and found too many bogus links. What is a reputable website to research this option?

You would be advised to visit www.medicare.gov/pharmaceutical-assistance-program/index.aspx to view the various pharmaceutical assistance programs. This site allows you to search pharmaceutical assistance programs by the brand name of the medicine. The site outlines the eligibility requirements and provides direct links to the pharmaceutical assistance programs.

Amy Rubino is the director of the Senior Health Insurance Assistance Program and the Senior Medicare Patrol for the Anne Arundel County Department of Aging and Disabilities. You may contact either program at 410-222-4257 or [email protected].

Credit: Amy Rubino