Medicare pays for hospital care but it has limits. For Part A coverage to kick in, you first need to be admitted as an inpatient. After that, how long Medicare covers your hospital care depends on how sick you are. This is what you need to know about lifetime reserve days.

Lifetime Reserve Days

It would make sense for Medicare to keep paying for hospital care no matter how long you needed it. After all, you are not hanging around for a good time. Your doctor or healthcare provider has a medical reason for keeping you there.

To control costs, Original Medicare sets a cap on long hospital stays. For every hospital stay longer than 90 days long, you are allowed a lifetime reserve day for each day starting on hospital day 91.

The catch is that you are only given 60 lifetime reserve days EVER. You do not get more the next year and you do not get a fresh batch with a new hospital stay. After you use up your 60 days, whether you use them all at once or across multiple hospital stays, you will have to pay for all hospital costs on your own.

Day of Inpatient Hospital Care	Your 2024 Costs
Inpatient hospital deductible for days 0-60	$1,632 per hospital stay
Inpatient hospital copayment for days 61-90	$408 per day
Inpatient hospital copayment for days 91+ (lifetime reserve days)	$816 per day

MEDICAL VS. PSYCHIATRIC:
Lifetime reserve days do not apply to psychiatric hospital stays or to stays at a skilled nursing facility.

How They Work

To understand how lifetime reserve days work, let’s use an example.

Sarah was hospitalized with COVID-19 in 2021. She was critically ill and required ICU treatment with a ventilator. She was eventually weaned off the ventilator, thank goodness, and was discharged to a skilled nursing facility on hospital day 100.

This hospital stay would use up 10 day lifetime reserve days (hospital days 91-100). This would leave her with 50 lifetime reserve days (60 days – 10 days) to use down the road.

Unfortunately, Sarah now has chronic lung disease. The next year, she stays in the hospital for 95 days in a row for treatment of pneumonia. She would use up another 5 lifetime reserve days (hospital days 91-95). This leaves her with 45 lifetime reserve days (50 days – 5 days) to use as long as she has Medicare.

HELPFUL TIP:
Medicare Advantage plans do not necessarily have a 60 day limit. You should talk to your plan about how they deal with hospital stays longer than 90 days.

How Benefit Periods Come Into Play

When you stay in the hospital for 90+ days in a row, it is easy to count off your lifetime reserve days. Not all hospital stays are that straightforward though. That’s why it’s important to understand benefit periods.

The Part A benefit period begins the day you have inpatient orders put on your hospital chart. Any days where you were “under observation” don’t count. Interestingly, the benefit period does not end when you leave the hospital. It lasts 60 days from the day you are discharged from the hospital or from a skilled nursing facility (if you were transferred to one of these facilities after your inpatient stay).

Why is that important? If you go home but are readmitted to hospital within the same benefit period, your hospital stay starts where your last one left off. For example, if you were hospitalized as an inpatient for 80 days, went home, and came back to the hospital 60 days after that, you would be in the same benefit period. Your readmission would start on hospital day 81, not hospital day 1. This puts you much closer to using your lifetime reserve days. However, if you came back to the hospital stay 61 days later, your hospital stay would start on day 1.

ANOTHER WAY TO LOOK AT IT:
A hospital stay can be new to you (60 days between hospital stays can feel like a long time!), but, in the eyes of Medicare, no time has passed.

Medical Conditions That Increase Hospitalizations

Life is unexpected. You never know when a a natural disaster will strike, when injuries will occur, or when you a major illness will sneak up on you. These situations not only increase your healthcare costs but could lead to hospitalizations.

Certain chronic medical conditions can increase your risk for hospital stays too. Having one of these conditions makes it more likely you could use lifetime reserve days over your Medicare experience.

According to the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services, chronic medical conditions associated with more frequent hospital stays include:

• Cardiac arrhythmias
• Chronic obstructive pulmonary disease (COPD)
• Chronic kidney disease
• Cirrhosis and other liver disease
• Diabetes
• Heart failure
• Human immunodeficiency virus (HIV)
• Sickle cell anemia

HELPFUL TIP:
If you have one of these chronic medical conditions, you will want to have a plan in place to keep hospital costs down. A Medigap plan may be the way to go.

Medigap Coverage

You can keep your out-of-pocket costs down by signing up for a Medicare Supplement Plan, also known as a Medigap plan. These plans help to pay for costs that Original Medicare (Part A and Part B) leaves on the table, costs like deductibles, coinsurance, and copays (but not premiums). Depending on the plan you choose, it could make your hospital care much more affordable.

Find a plan that pays your Part A deductible (hospital days 1-60), Part A coinsurance (hospital days 61-90), Part A coinsurance (hospital days 90+, a.k.a., lifetime reserve days), Part B coinsurance (physician fees), and SNF coinsurance (SNF days 21-100). All Medigap plans give you an additional 365 days of inpatient hospital care after you use up your lifetime reserve days.

REMINDER:
You cannot sign up for a Medigap plan if you have a Medicare Advantage plan.

Medicare Benefit Policy Manual Chapter 5 – Lifetime Reserve Days. CMS.gov. https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/bp102c05.pdf

Most Common Diagnoses in Hospital Inpatient Stays – HCUP Fast Stats | Agency for Healthcare Research and Quality. (2018). AHRQ.gov. https://www.hcup-us.ahrq.gov/faststats/NationalDiagnosesServlet

Overview of Clinical Conditions With Frequent and Costly Hospital Readmissions by Payer, 2018 #278 | Agency for Healthcare Research and Quality. (2018). Ahrq.gov. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb278-Conditions-Frequent-Readmissions-By-Payer-2018.jsp