Medicare Lifetime Reserve Days Explained

If you’re a Medicare beneficiary and require inpatient hospitalization, Medicare Part A will help cover the costs of your stay.

However, what happens if you end up needing to stay in the hospital for an extended period of time? For example, you might get COVID-19 and need to be on a ventilator while rebuilding your strength over several months. Or you might require around-the-clock care while recovering from a stroke.

Nobody wants to think about being in the hospital for months or how much that might cost, but it can happen – and being prepared financially can help.

In these cases, you may elect to use what are called your Medicare lifetime reserve days. Your lifetime reserve days can help you avoid having to pay the full cost for your inpatient hospital care, but you only have a limited number of these days to use over the course of your life.

This guide explains Medicare lifetime reserve days, how to use them during an extended inpatient stay and your coverage options for getting help paying some of your out-of-pocket Medicare costs.

What Are Lifetime Reserve Days?

Your lifetime reserve days are additional days that Medicare Part A will pay for if you have an inpatient hospital stay that lasts longer than 90 days. You only get a total of 60 reserve days to use during your lifetime; they don’t reset, and you can’t earn more.

For each lifetime reserve day you use during a hospital stay, Medicare pays all covered costs except for your daily coinsurance.

Some of the costs Part A covers if you’re admitted for inpatient care at a hospital, skilled nursing facility or other similar health care facility that accepts Medicare include:

• Semi-private room
• Meals
• Nursing care
• Drugs administered for your care
• Other costs related to your inpatient treatment

During each benefit period, Medicare covers up to 90 days of inpatient hospitalization. A benefit period starts when you’re admitted to the hospital and ends after you’ve been discharged and don’t receive additional inpatient care for 60 consecutive days.

If you’re re-admitted before 60 consecutive days have elapsed, it’s considered the same benefit period. If you’re re-admitted after 60 consecutive days, it’s considered a new benefit period.

Your Medicare lifetime reserve days are an extra 60 days of inpatient care (beyond the first 90) that you can use at any time during your life if you need them.

You can use lifetime reserve days in the same benefit period (if your hospital stay lasted up to 150 days, which isn’t typical), or you can use them over multiple benefit periods. One caveat? Once you use them, you lose them.

How Do Medicare Lifetime Reserve Days Work?

During your first 90 days of inpatient hospitalization, you must pay your Medicare Part A deductible before your Part A benefits kick in. In 2024, this amount is $1,632. For days 61-90 of your inpatient stay, you pay $408 per day.

If your hospital stay lasts longer than 90 days, you’ll pay $816 coinsurance per day for each lifetime reserve day you use, up to your 60 days. Medicare covers all other expenses.

If you choose not to use your Medicare lifetime reserve days after day 90 – or if you run out of lifetime reserve days – you pay the full cost for the rest of your hospital stay.

Consider this example: Mr. Jones had a 120-day Medicare-covered inpatient stay. This means he pays the Medicare Part A deductible and coinsurance for the first 90 days and uses 30 lifetime reserve days to cover the remaining time.

Once Mr. Jones has been out of the hospital for 60 consecutive days, he’s eligible for another 90 days of hospital coverage if he needs them. Because another hospital stay would count as a new benefit period (even if it’s in the same calendar year), he’ll have to meet the Part A deductible again and pay the Part A coinsurance for each day of his new hospital stay that lasts longer than 60 days. In this situation, he only has 30 of his 60 lifetime reserve days remaining to use if his new hospital stay lasts longer than 90 days.

Now consider this example. Mr. Jones is admitted for 120 days. He pays the Medicare Part A deductible and coinsurance for the first 90 days and uses 30 lifetime reserve days for the remaining time. However, he ends up being readmitted one week after discharge. This is considered the same benefit period, and thus his 90-day coverage has already been used.

He wouldn’t have to meet the Part A deductible again since it’s the same benefit period, but he would immediately need to decide whether he’d want to use any of remaining lifetime reserve days.

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What Happens When You Run Out of Medicare Days

When you reach your Medicare reserve day limit (benefit period), Medicare will stop paying for the remaining inpatient-related hospital costs. To be eligible to have a new benefit period you must be out of the hospital for 60 days. A new benefit period also means a new part A deducible as well.

How Will I Know When I’m About to Reach 90 Days of Inpatient Hospitalization?

The hospital will notify you at least five days before you’re set to hit the 90-day mark. Then, you can decide if you want to use or save your Medicare lifetime reserve days.

Depending on your hospital expenses, your lifetime reserve days may automatically kick in after 90 days unless you tell the hospital that you don’t want to use them. With that said, you have up to 90 days after discharge to change your mind either way. You’ll just need to let the hospital know (in writing) of your wishes.

Why Might I Not Want to Use My Medicare Lifetime Reserve Days?

One reason you might choose to save your lifetime reserve days is if the daily cost of your hospital stay is around the same amount as the coinsurance payment or less (as mentioned above, the 2024 coinsurance cost for lifetime reserve days is $816 per day). In this case, you may want to save your Medicare lifetime reserve days in case you need more expensive care in the future.

Another reason some people might save their lifetime reserve days in a certain situation is if they have other insurance options or coverage such as Medicaid that help pay for additional inpatient days beyond the first 90.

Each person’s situation is unique, and we encourage you to speak with your doctor and any case management team the hospital provides to learn more about the right choice for your hospital stay.

Can I Get Help Paying for My Hospital Expenses?

One way to get help paying for your out-of-pocket Medicare costs such as your Part A deductible and hospital coinsurance is to apply for a Medicare Supplement plan, also called Medigap.

Medicare Supplement plans help pay for several different Medicare out-of-pocket costs. Some Medigap plans, such as Plan G and Plan N, fully cover your Part A coinsurance and Part A deductible, which can help greatly reduce your out-of-pocket spending when you need inpatient hospital care.

You can compare Medicare Supplement plans online or call to speak with a licensed insurance agent who can help you learn more.