Medicare Coverage of Long-Term Care Hospitals
Long-term care hospitals (LTCH) provide acute care for Medicare patients who need extended or more intensive care. While many traditional hospitals are also “acute care hospitals,” LTCHs are licensed acute care hospitals that specialize in treating patients who need more time to recover.
Most inpatient acute hospital stays are short, while patients in long-term acute care hospitals may be fighting more than one condition or have more complicated illnesses. LTCH patients are often transferred from another hospital’s critical or intensive care departments. Long-term care hospitals are characterized as hospitals with average patients staying more than 25 days.
Medicare coverage of long-term care hospitals
Long-term acute care is covered under Medicare Part A (hospital insurance). Part A-covered hospital coverage includes:
- Inpatient hospital services and supplies
- Semi-private room
- Medications administered during your inpatient stay
Coverage in a long-term acute care hospital may also include:
- Rehabilitation services
- Pain management
- Treatment for head trauma
- Respiratory therapy
Part A coverage of long-term care hospitals does not include a private room, private-duty nursing, or personal care items (for example, a toothbrush or shampoo). It also does not cover the cost of a television or private phone in your hospital room if there is a separate charge.
Please also note that long-term hospitals do not provide “long-term care.” Medicare considers long-term care, or custodial care, to be primarily non-skilled assistance with daily living activities, such as getting dressed or bathing. Medicare doesn’t cover this type of care. In contrast, care received in a LTCH is skilled, inpatient care for patients who need longer recovery time.
Long-term care hospital costs
If you have Original Medicare, your costs at a long-term acute care hospital will be the same as an inpatient hospital stay. Under Medicare Part A, you’re responsible for:
- A one-time deductible per benefit period*
- Coinsurance costs if you stay longer than 60 days
*For Medicare coverage purposes, a benefit period begins on the first day you’re admitted to the hospital as an inpatient and ends when you haven’t received hospital or skilled nursing facility (SNF) care for 60 days in a row.
If you are admitted to a long-term acute care hospital within 60 days of being discharged from an inpatient hospital stay, you are still within the same benefit period and would not pay another deductible. The same, one-time deductible applies for each benefit period, whether that care happens in a hospital, SNF, or a long-term care hospital.
There is no coinsurance payment for the first 60 days of your benefit period. If your stay in the LTCH lasts longer than 60 days, there are daily copayment costs, depending on the length of your stay. After 90 days within the same benefit period, you are responsible for all inpatient costs. However, Medicare gives each beneficiary 60 “lifetime reserve” days that can be used to extend coverage in any benefit period. Once you have used up these lifetime reserve days, you pay 100 percent of all costs.
Private Medicare plans may help with minimizing out-of-pocket costs for LTCH stays. Medicare Advantage plans are another way to receive your Original Medicare benefits, and many offer additional coverage not included in Original Medicare, which may include help paying for LTCH stays.
All Medicare Supplement insurance plans cover the Part A coinsurance and inpatient costs for an extra 365 days after all Medicare benefits, including lifetime reserve days, have been exhausted. This benefit is especially useful for LTCH patients with chronic or more serious illnesses who need longer treatment and recovery time and don’t want to worry about running out of coverage. Many Medigap plans also cover the Part A deductible.
To view Medicare Advantage or Medicare Supplement insurance plans available in your area, simply enter your zip code into the form on this page. You can also compare plans at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), 24 hours a day, seven days a week.
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