Problem:

Mr. F has Original Medicare Parts A and B. He was in a Department of Veterans Affairs (VA) hospital. After three weeks in the hospital, he wanted to transfer to a Medicare-participating hospital closer to his home. Since VA facilities do not participate in Medicare, Mr. F did not know if the transfer would create any coverage problems.

What To Do:

Mr. F called his State Health Insurance Assistance Program (SHIP) hotline and found out that he could transfer. Although Veterans Affairs generally will not pay for a hospital stay in a non-VA hospital, Original Medicare will pay for his stay in the new hospital. Mr. F also learned that the three weeks he had already spent in the VA facility would not shorten the amount of time that Medicare would cover his care in the new hospital.

The 21 days Mr. F spent in the VA hospital would not count toward his Medicare benefit period  A Medicare benefit period begins when the person enters a hospital and ends when the person has been out of the hospital for at least 60 days in a row. Medicare will pay the full cost of the first 60 days he is in the Medicare-participating hospital after he has paid the $1,316 deductible. However, his deductible should be reduced or eliminated, Payments made by the VA for his VA hospital stay should be credited towards his Medicare Part A deductible. After that, during the same benefit period, Mr. F will have to pay a coinsurance of $329 each day for days 61 to 90, and $658 each day for days 91 to 150 (using his lifetime reserve days). Costs are for 2017 and change every year.

 

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