Medicare Answers: Medicare Supplement Lifetime Maximum?

  • Originally published April 2, 2012 , last updated December 23, 2014
  • Medicare
Medicare Answers: Medicare Supplement Lifetime Maximum?

If you have a Medicare question you’d like answered, email it to AskRoger@SeniorMarketSales.com.

This week’s question deals with lifetime maximums as it relates to Original Medicare and Medicare Supplement.

Hope asks:
“Does Medicare limit the coverage for their beneficiaries in reference to lifetime maximums, and do you know if Med Supp providers have lifetime maximums?”

Editor’s Note: The MA-PD that she is deciding whether to keep or replace has a $1 million lifetime maximum.

Hope,

Medicare Supplement benefits have to adhere to NAIC and state guidelines on what they can and cannot cover. I know of none that have defined lifetime Maximums. I will say that in 2012 $1 million in lifetime coverage is not much.

First, I will tell you how Medicare Part A covers it and then the Medicare Supplement and how a particular Gap is covered. Also even though hospital benefits are exhausted, Medicare Part B is still paying.

To start we need to understand a “Benefit Period” as it relates to your question. Medicare hospital benefits are paid on the basis of benefit periods. It starts the day a person with Medicare goes into the hospital or skilled nursing facility. It ends when the person has not received hospital or skilled nursing care for 60 days in a row. If a person with Medicare goes to the hospital again after 60 days, a new benefit period begins.

The reason I wanted to give this definition is it has a lot to do with when a person receives Part A Benefits. See how Medicare pays while in the Hospital. For each benefit period an individual pays: A total of $1,156 for a hospital stay of 1–60 days. $289 per day for days 61–90 of a hospital stay. Each benefit period you are hospitalized beyond 90 days you draw out a day from the Lifetime Reserve Day benefits and pay $578 per day for days 91–150 of a hospital stay and when all of the(Lifetime Reserve Days are gone , all costs beyond 90 days for each Benefit Period.

That being said, the Medicare Supplement fills the gaps with most of the plan options and throws another 365 days in the Lifetime Reserve bank. Again I will remind you these limitations are on Medicare Part A only.

With this explanation, is Original Medicare and a Medicare Supplement equal to an MA-PD’s $1 million Lifetime Maximum? Maybe.

Roger