Wellcare Dual Liberty (HMO D-SNP) (001): Inpatient Hospital Care

Inpatient care is defined as admission into the hospital under inpatient status.

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Cost
For Medicare-covered admissions, per admission: $0 copay for each hospital stay.
Prior Authorization Required
Yes, except in an emergency
Provider Referral or Order Required
Yes

How To Receive

Details on how to apply

  • For Medicare-covered admissions, per admission: $0 copay for each hospital stay.

  • Lifetime Reserve Days $0 copay per day.

    • Lifetime Reserve Days are additional days that the plan will pay for when members are in a hospital for more than the number of days covered by the plan.

    • Members have a total of 60 reserve days that can be used during their lifetime.

    • If you get authorized inpatient care at an out-of-network hospital after your emergency condition is stabilized, your cost is the cost sharing you would pay at a network hospital.

Includes inpatient acute, inpatient rehabilitation, long-term care hospitals and other types of inpatient hospital services. Inpatient hospital care starts the day you are formally admitted to the hospital with a doctor’s order. The day before you are discharged is your last inpatient day. You are covered for 90 days for Medicare-covered inpatient hospital stays.

Covered services include but are not limited to:

  • Semi-private room (or a private room if medically necessary)

  • Meals including special diets

  • Regular nursing services

  • Costs of special care units (such as intensive care or coronary care units)

  • Drugs and medications

  • Lab tests

  • X-rays and other radiology services

  • Necessary surgical and medical supplies

  • Use of appliances, such as wheelchairs

  • Operating and recovery room costs

  • Physical, occupational, and speech language therapy

  • Inpatient substance use disorder services

  • Under certain conditions, the following types of transplants are covered: corneal, kidney, kidney-pancreatic, heart, liver, lung, heart/lung, bone marrow, stem cell, and intestinal/multivisceral. If you need a transplant, we will arrange to have your case reviewed by a Medicare-approved transplant center that will decide whether you are a candidate for a transplant. Transplant providers may be local or outside of the service area. If our in-network transplant services are outside the community pattern of care, you may choose to go locally as long as the local transplant providers are willing to accept the Original Medicare rate. If our plan provides transplant services at a location outside the pattern of care for transplants in your community and you choose to obtain transplants at this distant location, we will arrange or pay for appropriate lodging and transportation costs for you and a companion.

  • Blood - including storage and administration. Coverage of whole blood and packed red cells begins with the first pint of blood that you need. All other components of blood are covered beginning with the first pint used.

  • Physician services

Note: To be an inpatient, your provider must write an order to admit you formally as an inpatient of the hospital. Even if you stay in the hospital overnight, you might still be considered an outpatient. If you are not sure if you are an inpatient or an outpatient, you should ask the hospital staff.

Availability
Ongoing, as medically necessary and authorized

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Inpatient care begins upon admission into the hospital as an inpatient (i.e., not as observation, which is still outpatient). Settings include inpatient acute, inpatient rehabilitation, long-term acute care hospitals (LTAC), and other types of inpatient hospital services. Inpatient hospital care starts on the day of formal admission into the hospital with a provider’s order and begins the benefit period (see below). The day before discharge is the last inpatient day. Except in an emergency, the provider must inform the plan of hospital admission. 

Covered services include but are not limited to:

To be an inpatient, the provider must write an order for admission as an inpatient of the hospital. Even if there is an overnight stay in the hospital, it might still be considered an outpatient. If inpatient or outpatient status is unclear, ask the hospital staff.

BENEFIT PERIOD: There is no limit to the number of benefit periods. A benefit period starts on the day of admission into a hospital or skilled nursing facility. It ends after 60 days in a row without hospital or skilled nursing care. Upon hospital admission, after one benefit period has ended, a new benefit period begins.

If inpatient care is received at an out-of-network hospital following the stabilization of an emergency condition, the coverages and costs will be the same as a network hospital. Admission to an out-of-network hospital without a preceding emergency, however, will cost more. For admissions without a preceding emergency (such as direct from a provider's office or outpatient facility), the provider should choose a network hospital.

*Coverage of whole blood and packed red cells begins only with the fourth pint of blood needed—costs for the first 3 pints of blood in a calendar year must be paid out-of-pocket or the blood must be donated from self or by someone else. All other components of blood are covered beginning with the first pint.

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