CASE FLASH: MEDICARE LIFETIME LIMIT ON INPATIENT PSYCHIATRIC HOSPITAL DAYS

Mr. A, a 75-year-old man with Original Medicare coverage, has a history of depression and eating disorders. Two years ago, he started having suicidal thoughts and was refusing to eat. His wife helped him find a psychiatric hospital, where he received inpatient care for a total of 140 days—he first went for 90 days, was out of the hospital for six months, then returned for another 50 days. Mr. A was able to live safely at home for the next year while going to see a psychologist as an outpatient. Then, a few months ago, Mr. A’s wife passed away. He began having suicidal thoughts again and returned to the same psychiatric hospital for inpatient treatment. Mr. A was in the psychiatric hospital for about 50 days when the hospital’s billing department informed Mr. A’s daughter that Medicare would no longer pay for Mr. A’s hospital stay. Mr. A was not yet well enough to return home, but the hospital said Mr. A could stay in the hospital only if he agreed to pay the full cost of the rest of his stay.

Mr. A’s daughter called the Medicare Rights Center and spoke with a hotline counselor about her father’s situation. The hotline counselor explained that Medicare covers a total of 190 days of inpatient care in a psychiatric hospital for your lifetime. Because Mr. A used 140 days two years ago, the current 50-day stay exhausted the rest of his inpatient psychiatric hospital coverage. However, the hotline counselor explained, Mr. A still could be covered by Medicare for inpatient mental health care; he just would need to get the care at a general hospital. There he would be covered for much of the cost of up to 100 more days.

Mr. A’s daughter contacted the psychiatric hospital with this information. Mr. A was transferred the next day to a general hospital where he continued to receive inpatient mental health care for another 25 days, and then was able to return home safely.

-Adapted from: MEDICARE WATCH , a biweekly electronic newsletter of the Medicare Rights Center, Vol. 11, No. 13: June 24, 2008.

 

06/08