Medicare Part A plans have lifetime reserve days that a person can use for an inpatient hospital stay that stretches beyond 90 days. Out-of-pocket costs may still apply.
Medicare is a health program federally funded for adults aged 65 and older, or those under 65 with specific disabilities.
Medicare Part A covers eligible inpatient hospital charges for up to 90 days, making the coverage dependent, in part, on the length of the hospital admission.
Medicare offers lifetime reserve days, which provides coverage beyond the 90-day limit.
This article looks at Medicare lifetime reserve days, their rules, costs, and how a person may get extra help towards any fees they pay out of pocket.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare involves different parts, including parts A, B, C, and D. Different parts of Medicare cover various healthcare needs.
Part A covers inpatient hospital care, including stays in various types of facilities, including:
- acute care hospitals
- rehabilitation hospitals
- skilled nursing facilities
- psychiatric hospitals
Medicare Part A also covers certain home health services and hospice care.
Other parts of Medicare cover different aspects of health needs, such as outpatient doctor’s visits and prescribed medication.
Medicare Part A covers eligible inpatient costs for a hospital admission that lasts between 1 and 90 days.
Medicare provides additional coverage for hospital stays that go beyond 90 days. This extra coverage is known as lifetime reserve days.
Beneficiaries receive 60 lifetime reserve days that begin on day 91 of hospitalization. Once a person uses their 60 lifetime reserve days, they do not get more.
The lifetime reserve days are available for anyone with Part A, but copayments still apply.
Due to the standard coverage limit being 90 days, some people may never use their lifetime reserve days.
Medicare Part A coverage includes most services and care related to an inpatient hospital stay, including:
- hospital rooms (semi-private)
- general nursing care
- hospital services and equipment
Before Medicare covers an inpatient stay, the beneficiary pays a deductible. In 2021, the Part A deductible is $1,484 per benefit period.
Medicare Part A measures the use of inpatient services according to the benefit period.
The Medicare benefit period starts on the first day a person is admitted to a hospital and ends when a person has been home from the hospital for 60 days.
Once discharged from the hospital, should an individual need to be readmitted within 60 days, the same benefit period would apply. In this case, the Part A deductible would not need paying for a second time.
In 2021, Medicare Part A has the following copayments:
- day 1-60: $0 copayment
- days 61-90: $371 per day copayment
- days 91 and beyond: $742 copayment per day when using lifetime reserve days
- after lifetime reserve days have been used the beneficiary pays all costs
Medicare has specific rules that apply to lifetime reserve days.
The lifetime reserve days do not apply to stays at skilled nursing facilities and stays at psychiatric hospitals.
Medicare does not cover all costs when a person uses lifetime reserve days.
Part A coverage involves copayments, and the costs may change each year. In 2021, the copayment is $742 per day for each lifetime reserve day used.
After using all lifetime reserve days, a person must pay all hospital costs in full.
Choosing when to use lifetime reserve days
Sometimes, a person may choose not to use their lifetime reserve days and, instead, save them for later.
An individual does not have to apply all lifetime reserve days to the same hospital stay. For example, someone may have one hospitalization period that used ten lifetime reserve days. A year later, they may choose to use another ten lifetime reserve days for another lengthy hospital stay.
Hospitals generally notify patients around a week before their Medicare-covered hospital days expire.
At that time, an individual may choose not to use their lifetime reserve days, and they should indicate that wish in writing to their hospital.
A person may be able to get extra coverage to help with extended hospital stays, and individuals with a limited income may be eligible for additional support with out-of-pocket costs.
Medicare Savings Programs
The Qualified Medicare Beneficiary (QMB) program is one of four Medicare savings programs.
QMB programs offer help with out-of-pocket expenses. To qualify, an individual must meet specific income and resource requirements.
In 2020, income and resource limits are:
|Single monthly income limit||Married monthly income limit||Individual resource limit||Married resource limit|
The income limits may change every year.
Medicare supplement insurance, also known as Medigap plans, are available to individuals with original Medicare who may prefer not to use lifetime reserve days.
Medigap policies typically cover an additional 365 days of inpatient hospitalization after a person has used all lifetime reserve days.
Private insurance companies administer Medigap policies, and a person can compare plans using a helpful tool on Medicare’s website.
Medicare Advantage plans, also known as Medicare Part C, offer alternative options that may help with the out-of-pocket costs associated with prolonged hospital stays.
Private medical insurance companies also administer Medicare Advantage plans.
Usually, Medicare Advantage plans have caps for out-of-pocket expenses. This means a person only pays up to a certain amount themselves, regardless of how many days they are in the hospital.
An individual is not able to have both Medicare Advantage and Medigap policies at the same time.
Insurance companies are not legally allowed to sell a Medigap policy to someone with Medicare Advantage.
Medicare Advantage plans can be compared on the Medicare website using their Medicare Advantage search tool.
Lifetime reserve days are additional days that Medicare Part A covers for extended hospital stays.
Medicare offers 60 lifetime reserve days that begin on day 91 that a person is required to remain in hospital.
When a person chooses to use their lifetime reserve days, copayments will still apply. In 2021, the copayment for lifetime reserve days is $742 per day.
Once a person uses all 60 of their reserve days, they will be fully responsible for further expenses.
There are alternative options that a person can explore, including enrollment in a Medigap or Medicare Advantage plan.
For individuals with limited income and resources, additional support is available.