If you’re ever in a situation where you need to be admitted to a hospital, knowing about your Medicare health insurance coverage can be a big stress relief.
We’ve put together this article about Medicare Lifetime Reserve Days to help you understand what costs you can expect if you have to stay in hospital for a long time.
Benefits Period - This is the length of time that you will get Medicare cover. Your benefit period begins on the day you are admitted to the hospital and after you've been discharged for 60 days.
Coinsurance - These are rates you will have to pay after receiving medical treatment, services, and items. For Part A, these are calculated based on the number of days that you are hospitalized.
Deductibles - The amount you have to pay before your medical costs (Both Part A and Part B) are covered by Medicare. In 2022, the deductible cost for Part A expenses is $1,556.00 per benefit period.
If you’re enrolled in Medicare, Part A will pay for inpatient care and hospital services such as specialized medical care and general nursing.
It will not cover expenses like private hospital rooms, specialist consultations, personal care items, or private nurses.
Most people think that Medicare pays for all their inpatient care costs, but this isn’t always true. There are limits to how long your coverage will last.
Part A will only cover expenses for the first 60 days of inpatient hospital stays, and you won’t have to pay anything for your inpatient costs.
Take a look at this table to see what you can expect to pay for hospital care with Part A cover.
|Medicare Part A Coinsurance Hospital in 2021|
|0 - 60 Days|
|61 - 90 Days|
|91 - 150 Days|
Although Medicare will cover all of your inpatient hospital care costs after 60 days, you will have to pay a coinsurance amount thereafter. This amount will be $371.00 for each day.
After 90 days, coinsurance costs will increase to $742.00 for each day you spend in the hospital.
On top of these coinsurance amounts, you’ll also tap into your Lifetime Reserve Days if you spend more than 90 days in the hospital.
Medicare Lifetime Reserve Days limit the number of days that Medicare Part A will cover expenses for extended hospital stays.
Some important points about Lifetime Reserve Days:
Each person gets 60 Lifetime Reserve Days.
These days are not renewable, and once you use them they can’t be used again.
If you use your Lifetime Reserve Days, Medicare will cover your treatment costs and you will have to pay a coinsurance amount ($742.00 per day).
You can choose to use your Lifetime Reserve Days or save them if you are hospitalized for longer than 90 days during your benefit period.
Remember, a benefit period is the length of time during which Medicare will cover medical expenses. For Part A, your benefit period begins on the day you are admitted as an inpatient and ends after you have not received inpatient treatment for 60 days.
For example, if you are admitted on March 1st and stay in the hospital for 12 days your benefit period will start on March 1st. It will end 60 days after you leave the hospital and don’t receive any more hospital care. In this case, your benefit period would end on May 12th (March 13th—when you leave the hospital—plus 60 days).
It’s important to remember that your Lifetime Reserve Days will only be affected if you receive inpatient hospital care for more than 90 days during a benefit period.
If you are hospitalized over multiple benefit periods but don't receive 90 days of treatment during each benefit period, your Lifetime Reserve Days won't be affected.
Medicare is the federal health insurance program for people over 65, disabled individuals, and those who suffer from ESRD (End-Stage Renal Disease).
Original Medicare is divided into Part A and Part B.
Part A deals with inpatient hospital expenses. For example, if a person is hospitalized because of a chest infection or severe illness.
Part B covers general medical (outpatient) expenses for tests, items, and services outside the hospital. For example, if you get X-rays done at your doctor’s office or if you go for a consultation with a specialist.
Medicare Advantage, Part D Plans, and Medicare Supplement Insurance.
Medicare Advantage, previously known as Part C, is health insurance cover provided by private insurance companies contracted into the federal Medicare program.
Medicare Part D covers prescription medication costs and is available to people who don’t have Medicare Advantage or a Medicare Supplement Insurance plan.
Medicare Supplement Insurance, sometimes known as Medigap, are policies that people on Original Medicare can join to cover the costs of their medical expenses.
Lifetime Reserve Days can be confusing and might significantly impact your finances if you don’t understand how they work.
Let's look at some examples to give you a better idea of how Lifetime Reserve Days could affect you in different situations.
If you were hospitalized for 65 days, you’d have to pay $1,9455.00 in coinsurance costs ($389.00 for each day).
Out of pocket expenses for your hospital stay:
Your total out-of-pocket costs (Part A coinsurance ($1,945.00) and deductible ($1,556.00)) for a 65-day inpatient hospital stay would be $3,501.00.
If you stayed in the hospital for 92 days, you’d have to pay $389.00 for days 61 to 90 and then pay $778.00 for the days after that.
Out of pocket expenses for your hospital stay:
Your total out-of-pocket costs (coinsurance ($11,670.00 + $1,556.00) and deductible ($1,556.00)) for a 92-day hospital stay would be $14,782.00.
If you are hospitalized for 100 days because of a severe illness or an accident, you can choose to pay for the last ten days (Day 90 onwards) out of your own pocket and not use your Lifetime Reserve Days.
Out-of-pocket expenses for your hospital stay:
If you don’t use your Lifetime Reserve Days, you will have to pay your normal out-of-pocket expenses (coinsurance and deductible ($11,670.00 + $1,556.00) plus the full costs of your hospital expenses for the ten days (10 x $2607.00 = $26,070.00 (in 2019)).
This would mean you could pay $39,296.00 or more in hospital expenses.
If you decide to use ten of your Lifetime Reserve Days, Medicare will cover all your medical hospital expenses and you will have to pay:
This would mean you would pay $21,006.00 ($1,556.00 + $11,670.00 + $7,780.00).
If you were admitted to the hospital in January 2022 for 60 days and then again in June 2022 for 40 days, your Lifetime Reserve Day quota wouldn’t be affected because there were two benefit periods.
But if you were in the hospital for more than 60 days, for example from January 1st to May 1st (one benefit period), your Lifetime Reserve Day quota would be affected if you decided not to pay the bill out of your own pocket.
If you are enrolled in a Medicare Supplement Insurance Plan, your policy might cover your coinsurance payments.
If you have Medicare Supplement Insurance, your plan is required to offer you hospital care cover beyond the 150-day Lifetime Reserve limit that Original Medicare offers. This amount is usually limited to 365 days of inpatient hospital care in your lifetime.
Some Medicare Advantage plans subsidize the cost of your extended hospital stays, while others will have no limit on the number of inpatient hospital days that their members can use.
Your Medicare Advantage plan will offer different coverage options based on your plan and area. You’ll have to contact your specific provider to find out what your plan’s hospital benefits are.
If you’re wondering what Medicare coverage your current plan offers, want to know more about your Lifetime Reserve Days, or find out how you can move to a better plan, email PolicyScout’s trained consultants at Help@PolicyScout.com to get answers.
If you’d like to learn more about Medicare and your health coverage options, visit our Medicare Hub to learn about Medicare-related topics such as costs, coverage, private plans, and benefits.
We also have a team of skilled Medicare consultants on hand to answer your questions and help you with choosing the best plans and providers in your area.