IBM Medicare Via Benefits Extend Health Medicare Hospital Days Coverage

Medicare's hospital inpatient coverage is probably the least talked about topic in private insurance marketing campaigns.  That statement is true whether an insurance company is pitching a Medicare Supplement plan (aka medigap) or a Medicare Advantage plan.  Maybe it is not advertised because it is easier to understand copays for a doctor visit.  Mostly, it is too complex to describe in a 30 second ad or a flyer.

Nonetheless, it is the part of Medicare coverage that is the most expensive and if a Medicare consumer doesn't understand the structure it can have both financial and health treatment impacts that are life altering.

The Medicare agency government rules for hospital coverage are straight forward and all Medicare insurance must cover these benefits.  By law, the basic amount of hospital stay coverage is the same irrespective of what type of Medicare insurance:
   

1. There are 90 days of coverage in each benefit period.
         
2. A benefit period begins when the patient is admitted as an inpatient (so "observation" doesn't count as a hospital day).
        
3. A benefit period ends 60 days after the patient leaves the hospital.
         
4. If the patient needs more than 90 days in a hospital in a benefit period, they have an addition 60 "lifetime" days that they can use to extend the 90 day stay.  The "lifetime" number is 190 days if it is a psychiatric hospital.
         
5. If a patient is discharged from a hospital and not readmitted until 61 or more days later, the patient begins a new benefit period.
       

Here is what is not straight forward.  How much do you pay when admitted to the hospital as an inpatient and for hospital days?  What happens if you need more than 150 contiguous days (in the same benefit period) in the hospital because of a dire condition?  What happens if you are hospitalized 3 times in a given year and each time a new benefit period started because you were "out" more than 60 days before being readmitted?

The cost of a hospital stay very much depends on the kind of insurance you have.  It can actually be zero or many thousands of dollars. This is where it gets complicated.  But it's important to understand it. 

The only way to compare original Medicare with Medicare Advantage is to compare costs. To properly compare costs, original Medicare with a Medicare Supplement (aka medigap) are used in the table below.  I used a premium price that is typical for an "N" medigap plan and picked a real Medicare Advantage plan that had a $0 premium. Without a medigap, there is no cap on the annual cost a person can incur in original Medicare.  Medicare Advantage plans do have a cost cap (in 2019 the max can be as much as $6,700 for "in network" services and is the cap for the MA plan I picked).  That $6,700 can buy a very nifty medigap  which is why I am including medigap in this comparison. Also, whether you use original Medicare or a Medicare Advantage plan, you MUST always pay the "part B" fee (currently $135.50/mo). What follows are 2019 numbers:    

Phase	Original Medicare +  Medigap N at $150/mo	Sample MA plan $0 premium
Hospital Benefit period  (Every 60 days if discharged and out of hospital for 60 days)	$1364 deductible Medigap N pays deductible	$0 deductible
Hospital day copay per benefit period	$0 days 1-60  $341 days 61-90  $692 for 60 lifetime days Medigap N pays all the copays	$465 days 1-4 $0 days 5-90 $0 for 60 lifetime days
If exceed 150 days in hospital	All Medigaps provide the extra days benefit of 365 days at $0 copay	No Medicare Advantage plan has extra days benefit, must pay full day cost for days over 150
Maximum hospital  cost in 2019	Medigap premium x 12 (approx. $1800 for 2019)	$6,700 for 2019 (if do not exceed 150 days)