What Are Medicare Lifetime Reserve Days?

If you’re admitted to a hospital or long-term care facility for inpatient care, Medicare Part A covers up to 90 days of treatment during each benefit period. If you need to remain in the hospital after those 90 days are up, you have an additional 60 days of coverage, known as lifetime reserve days.

You should know a couple of important things about lifetime reserve days.

First, your 60 lifetime reserve days don’t renew if you start a new benefit period. This set of extra days can only be used once in your life.

Second, you’ll pay coinsurance for each lifetime reserve day you use. In 2021, this amount is $742 for each lifetime reserve day.

Let’s say you have a hospital stay that lasts for 110 days. Here’s how the costs would break down:

• Days 1 through 60. In 2021, you pay a Part A deductible of $1,484. After that, Medicare pays the full cost for 60 days of inpatient care. The only time you might have an extra cost is if your doctor ordered a service or treatment that’s not covered by Medicare.
• Days 61 through 90. In 2021, you would pay $371 per day as coinsurance.
• Days 90 through 110. You can use 20 of your lifetime reserve days, paying $742 per day in 2021. If you don’t want to use up your lifetime reserve days, you can choose to pay the full cost of the 20 extra days in the hospital.

Let’s continue the scenario above. After your initial stay, you’ve been released and are out of the hospital for at least 60 days. If you’re admitted to the hospital again, a new benefit period will start.

Once the new benefit period begins, you’re eligible for another 90 days of inpatient hospital care. You’ll also have to pay a new deductible. If you again need to stay in the hospital longer than 90 days, you’ll have only 40 lifetime reserve days left to use, assuming you decided to use 20 during your first stay.

The hospital will notify you as you get close to using up your 90 days of coverage under Medicare Part A. At that point, you can let the hospital know if you want to save or use your lifetime reserve days.

If you don’t use your lifetime reserve days, the hospital will bill you for the days you’re in the hospital past your 90-day limit.

So, what happens if you decide later that you didn’t really need to use lifetime reserve days, and you’d like to pay the full cost instead?

You can let the hospital know (in writing) that you don’t want to use your lifetime reserve days after all. You have up to 90 days after you’re discharged from the hospital to do this.

If the daily cost of your stay in the hospital is around the same as your coinsurance payment, it might be wise to save your lifetime reserve days in case you need more expensive care later in your life.

Most people with Medicare coverage don’t have to pay a monthly Part A premium. Your daily out-of-pocket costs for a Medicare-covered hospital stay vary depending on how long you are hospitalized.

Keep in mind these costs:

• Your deductible for each benefit period is $1,484 in 2021.
• Your coinsurance cost for days 1 through 60 is $0.
• Your coinsurance cost for days 61 through 90 is $371 per day.
• Your coinsurance cost for days 91 and beyond is $742 per lifetime reserve day that you use.

Coinsurance costs typically increase each year. The chart below will give you an idea of how much costs have risen over the previous 5 years.

How does a Medigap policy affect my costs?

If you have a Medigap policy, it can help you pay your coinsurance costs.

All Medigap plans will pay your hospital coinsurance and give you up to an additional 365 days of inpatient hospital care after you’ve used your lifetime reserve days. Medigap plans A through N will pay some — if not all — of the cost for your hospital (Part A) deductible.

What about Medicare Advantage plans?

Medicare Advantage (Part C) plans are offered by private insurance companies. These plans must provide at least the same benefits as original Medicare (parts A and B).

If you have a Medicare Advantage plan, talk to your insurance provider or consult your plan documents to find out what your costs will be for hospital stays longer than 90 days.

If you still have questions…

For additional help understanding your Medicare lifetime reserve days or other benefits, try these resources:

• You can contact Medicare directly at 800-MEDICARE (800-633-4227).
• Get help from trained, impartial counselors through your local State Health Insurance Assistance Program (SHIP).
• Look for programs that can help you pay Medicare costs through state Medicare savings programs.
• Find a Medigap policy to help you pay coinsurance and deductibles using Medicare’s plan finder tool.

If you receive inpatient care in a hospital or long-term care facility for longer than 90 days, Medicare Part A gives you 60 extra days of coverage called lifetime reserve days.

This set number of lifetime reserve days can be used only once over the course of your lifetime. Once you’ve used them all, you’ll pay the full cost of hospital stays that are longer than 90 days at a time.

When you use lifetime reserve days, you pay a coinsurance fee of $742 per day in 2021. This is in addition to your Medicare Part A deductible of $1,484 per benefit period.

If you think you may need more coverage, you can purchase a Medigap policy, which can provide additional lifetime reserve days or pay for your Part A deductible.

Medicare plan options and costs are subject to change each year.