Medicare Part A, or Hospital Insurance, covers inpatient services in acute care hospitals and Skilled Nursing Facilities (SNFs). The limits on coverage length often cause confusion, particularly regarding the federal provision known as Lifetime Reserve Days (LRDs). LRDs are designed to extend coverage in one setting but have specific limitations in others. Understanding the rules for each facility type is necessary to determine if an extended SNF stay would be covered.
Medicare Coverage Limits for Skilled Nursing Facilities
Medicare Part A coverage for a stay in a Skilled Nursing Facility is regulated by the “benefit period.” To qualify, a beneficiary must first meet the “3-day stay rule.” This requires a medically necessary inpatient hospital stay of at least three consecutive days before admission to the SNF. Time spent under observation status does not count toward this requirement.
Once qualified, coverage is capped at a maximum of 100 days within a single benefit period. The financial structure is divided into tiers based on the length of the stay. For the first 20 days, Medicare covers the entire cost of skilled services, resulting in a zero-dollar coinsurance for the beneficiary.
Full coverage transitions on day 21, when a daily coinsurance payment becomes the beneficiary’s responsibility. For example, the coinsurance for days 21 through 100 is $209.50 per day in 2025. After the 100th day of a covered stay, Medicare Part A coverage for SNF services ceases entirely. The beneficiary is then responsible for 100% of the costs, unless a new benefit period begins after a break in skilled care of at least 60 consecutive days.
Defining Lifetime Reserve Days
Lifetime Reserve Days (LRDs) are a finite, non-renewable benefit provided under Medicare Part A. Every Medicare beneficiary receives a total of 60 LRDs to be used over their entire lifetime. These days are specifically intended to provide financial assistance for an extended stay in an acute care inpatient hospital.
LRDs become available only after a beneficiary has used the standard 90 days of inpatient hospital coverage within a single benefit period. Once used, these days are permanently deducted from the total 60-day allotment. Using an LRD requires the beneficiary to pay a statutory daily coinsurance, which is higher than the coinsurance for a standard hospital stay.
The daily coinsurance for an LRD is set at half of the inpatient hospital deductible for that year. For example, the daily coinsurance is $838 in 2025. Beneficiaries can elect not to use their LRDs during an extended hospital stay, choosing instead to save them for a future hospitalization.
The Application: Why LRDs Do Not Cover SNF Stays
Lifetime Reserve Days cannot be used for Skilled Nursing Facility stays. The statutory language creating LRDs strictly limits their application to extending coverage for inpatient hospital services beyond the 90-day limit. This framework establishes a clear distinction between the purpose of LRDs and the coverage limitations for SNFs.
The 100-day maximum for SNF care is a fixed limit within the Medicare Part A benefit structure. This limit is not modifiable by the LRD provision. LRDs function only to add 60 days to the 90-day hospital benefit, creating a 150-day maximum for inpatient hospital care.
Once a beneficiary uses all 100 days of the SNF benefit, financial responsibility shifts entirely to them. Options for continuing care include paying for services out-of-pocket (private pay). Alternatively, the beneficiary may have a supplemental insurance policy, such as a Medigap plan, that covers the daily coinsurance or provides limited additional days of coverage.
Individuals with limited financial resources can apply for Medicaid, which is a state and federal program that covers long-term care for those who meet specific income and asset requirements. The absence of LRDs for SNF stays means that planning for potential long-term care costs is a necessity, as Medicare Part A is fundamentally designed to cover short-term, post-acute care and not extended custodial nursing home care. The 100-day cap remains firm, and the LRD provision offers no recourse for extending this particular benefit.