Lifetime Reserve Days

Lifetime reserve days as described in the insurance industry is the 60 days additional to the beneficiary that Medicare pays that can be draw upon when the inpatient has already used the 90 days benefit period. The payment of those additional days of hospital care and services will be made right after the benefit period have been used unless the patient will choose not to use the reserve days and use it on the later time of life. However, these reserve days could only be utilized once in the whole lifetime. Moreover, these days are paid by the Medicare that will include all the costs except with a coinsurance amount. A coinsurance amount is half the patients deductible in the hospital.

One concrete example of reserve days is when an in-patient stays 95 days in the hospital which includes the benefit period of 90 days, the beneficiary may choose to use his/her lifetime reserve days of 5 days thus the total reserve days of 60 will be reduced to 55 days.

What is the effect of guarantee of payment provisions in reserve days?
The guarantee of payment provisions covers the hospital services employed to individuals who used their eligibility for hospital services and excludes those beneficiaries who have no eligibility for any coverage for certain reasons such as those individuals who are not entitled with health insurance or whose insurance have been revoked. Under this provision, the hospital can be paid in some certain situations. This provision will not be applied if the individual didn’t use his/ her lifetime reserve days with hospital services unless the beneficiary will elect not to use it for the mean time.

Are reserve days available to those in-patients in the hospitals if there average charge does not surpass half of their deductible?
The beneficiary will consider in choosing not to utilize the lifetime reserve days if the daily charge average for the services and care covered in the hospital in the lifetime reserve days charging period would be less than or equal the coinsurance amount of a lifetime reserve days. Those days on that period will be considered as noncovered instead of a possible lifetime reserve days because the beneficiary will be forced to pay on all the hospital bills even if he/ she chose to not use the lifetime reserve days. Therefore, the beneficiary won’t receive any beneficiary of the reserve days. This regulation is mostly used by the hospitals that are not paid by PPS.

Are lifetime reserve days available in Hospital Emergency Services?
Yes, lifetime reserve days are made available hospital emergency services most especially supplied and contained in nonparticipating hospitals.

When will be the payment for reserve days is made?
Once the patient already used the services of the benefit period coverage of 90 days and elect to use the lifetime reserve days, the payment will be made upon the request of the patient unless the patient will put into writing or in words that he/ she will not use the services of the program in that certain period of time.