Medicare Part A plans have lifetime reserve days that a person can use for an inpatient hospital stay that stretches beyond 90 days. However, out-of-pocket costs, like coinsurance, still apply.
Medicare is a federally funded health program for adults ages 65 years and older or those under 65 years with specific disabilities.
Medicare Part A covers inpatient hospital stays for up to 90 days. This can make coverage dependent, in part, on the length of the hospital admission.
Part A covers inpatient hospital care, including stays in various types of facilities, including:
- acute care hospitals
- rehabilitation hospitals
- skilled nursing facilities
- psychiatric hospitals
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part A covers eligible inpatient costs for a hospital admission that lasts between 1 and 90 days.
However, Medicare provides additional coverage for hospital stays beyond 90 days, which is called lifetime reserve days.
People with Medicare Part A 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 to anyone with Part A, but coinsurance still applies. Due to the standard coverage limit being 90 days, some people may never use their lifetime reserve days.
Medicare has specific rules that apply to lifetime reserve days.
Exclusions
The lifetime reserve days do not apply to stays at skilled nursing facilities (SNF). For stays at an SNF, Medicare covers up to 100 days of care. After 100 days, the individual is responsible for paying all costs.
Coinsurance
Medicare does not cover all costs when a person uses lifetime reserve days.
Part A coverage involves coinsurance, and the costs may change each year. In 2025, the coinsurance is $838 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 uses 10 lifetime reserve days. A year later, they may choose to use another 10 lifetime reserve days for another lengthy hospital stay.
If an individual does not wish to use their lifetime reserve days, they should indicate that wish in writing to their hospital.
Extra coverage may be available to help with extended hospital stays, and individuals with limited incomes 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 2025, income and resource limits are as follows:
| Individual monthly income limit | Married monthly income limit | Individual resource limit | Married resource limit |
|---|---|---|---|
| $1,325 | $1,783 | $9,660 | $14,470 |
The income limits may change every year.
Medigap
Medicare supplement insurance (Medigap) is 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 this helpful tool on Medicare’s website.
Medicare Advantage
Medicare Advantage (Part C) plans 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.
In 2025, the maximum out-of-pocket limit (MOOP) is $9,350. However, some plans may set lower limits.
A note on Medicare Advantage and Medigap
An individual cannot have both Medicare Advantage and Medigap policies at the same time, and insurance companies are not legally allowed to sell a Medigap policy to someone with Medicare Advantage.
A person can compare Medicare Advantage plans on the Medicare website using its Medicare Advantage search tool.
Medicare Part A coverage includes most services and care related to an inpatient hospital stay, including:
- hospital rooms (semiprivate)
- general nursing care
- hospital services and equipment
- medication
- meals
Before Medicare covers an inpatient stay, the beneficiary pays a deductible. In 2025, the Part A deductible is $1,676 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, a person would not need to pay the Part A deductible for a second time.
In 2025, Medicare Part A has the following coinsurance amounts:
- Days 1 to 60: $0 once the deductible is met
- Days 61 to 90: $418 coinsurance per day
- Days 91 and beyond: $838 coinsurance per day when using lifetime reserve days
After a person has used all lifetime reserve days, they must pay all costs.
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 when a person is required to remain in the hospital.
When a person chooses to use their lifetime reserve days, coinsurance will still apply.
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 also available.
