The extraordinary cost of health care for senior citizens makes it important for elder law attorneys to be able to explain the basic coverage of Medicare and Medicaid. These programs frequently require cost sharing on the part of the patient. At the beginning of each year the amounts charged under these two programs are recalibrated. These figures are critical in making calculations of the amounts patients in hospitals and in nursing homes are obligated to pay. The numbers also determine when coverage ends. Included here are the most commonly referred to figures and a brief explanation of their importance for hospital and nursing home care.
Medicare 2013
Medicare is the primary health insurance program for individuals over the age of 65. The basic rules of Medicare hospital and nursing home coverage are based upon the concept of the "benefit period." It starts upon the first hospital admission. The patient is responsible for a deductible of the first $1,184. Medicare then pays in full through the 60th day. The patient who remains in the hospital past the 60th day is responsible for coinsurance of $296 per day for days 61 through 90 and $592 for days 91 through 150 (called lifetime reserve days). These calculations are repeated when a new benefit period begins; however Medicare lifetime reserve days are not renewable once they are used.
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