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Health Care Reform:

Health Insurance & Affordable Care Act

Answers to your questions about how health care reform affects Medicare.

WebMD Feature

Health Care Reform and Medicare: FAQ

When it comes to health insurance, few topics gain as much interest from WebMD readers as Medicare and the impact that health reform will have on seniors’ health care benefits.

Here are answers to some of your most frequently asked Medicare-related questions.

Q: Will Medicare have a lifetime limit or has that been eliminated?

A: Generally, there are no lifetime limits on how much Medicare will spend on your medical treatment over the course of your lifetime, a fact that has nothing to do with health reform.

But there are exceptions.

For example, there is a lifetime limit of 190 days for inpatient psychiatric care, which has not changed under the Affordable Care Act. That limit may be lifted in the future, however. Sens. John Kerry (D-Mass.) and Olympia Snowe (R-Maine) just introduced a bill eliminating psychiatric care caps. If passed, this would ensure that beneficiaries receive psychiatric care benefits that are equal to the medical benefits provided under Medicare.

Medicare also limits the number of days it will pay for hospital stays that exceed 90 days. Hospitalization that lasts between 91 and 150 days will draw on a 60-hospital day lifetime reserve that can be used to cover the costs of long-term hospital stays. “Every day you draw from those days is gone forever,” says Judith Stein, executive director of the national nonprofit, nonpartisan Center for Medicare Advocacy.

Q: What about annual limits to care?

A: For some types of treatment, there are limits to how much Medicare will spend on care each year. Those limits depend entirely on the type of service and/or the setting in which it’s provided.

For example, in 2010 there was an annual cap of $1,860 for a combination of speech and physical therapy and another $1,860 for occupational therapy, unless the service was provided in a hospital outpatient clinic or emergency room. “If you go to an outpatient center, under Medicare there is a dollar cap,” Stein says.

Q: Are there limits to how much of my own money I will have to spend in a year for care?

A: No. There is no limit to how much money you may have to spend on your care, which is why Medigap plans -- which pick up the cost of co-pays, deductibles, and other expenses -- are so important.

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