Medicare Part A, or Hospital Insurance, covers medically necessary post-hospital care, including short-term stays in a Skilled Nursing Facility (SNF). Although Part A covers both inpatient hospital care and SNF care, they are structured as two distinct benefits with separate limitations. When the initial SNF benefit period nears its end, beneficiaries often ask about extending coverage. Medicare’s Lifetime Reserve Days (LRDs), which apply only to extended hospital stays, cannot be used to prolong coverage for an SNF stay. This separation is based on the specific design of the Medicare program.
Understanding Medicare Skilled Nursing Facility Coverage
Medicare Part A covers skilled nursing care following a qualifying hospital stay. Qualification requires the person to have been admitted as an inpatient to a hospital for a minimum of three consecutive days. The patient must then be admitted to a Medicare-certified SNF, usually within 30 days of discharge, to receive skilled services related to the hospital condition.
This coverage is tracked within a “benefit period,” which starts when a person enters a hospital or SNF and ends after 60 consecutive days without inpatient or skilled care. Medicare limits the SNF benefit to a maximum of 100 days per benefit period, provided the patient requires daily skilled care.
For the first 20 days of the SNF stay, Medicare covers the full cost after the initial Part A deductible is met. For days 21 through 100, the beneficiary is responsible for a daily coinsurance amount, set at $209.50 in 2025. If the medical need for daily skilled services ends, or the patient reaches the 100-day limit, Medicare coverage ceases.
The Purpose of Lifetime Reserve Days
Lifetime Reserve Days (LRDs) are a specific feature of Medicare Part A designed to protect beneficiaries during extremely long inpatient hospital stays. Each beneficiary is allotted 60 non-renewable reserve days to be used over their entire lifetime. These days become available only after a patient exhausts the standard 90 days of hospital coverage within a single benefit period.
When LRDs are used, Medicare continues to pay for covered services, but the beneficiary pays a daily coinsurance, which is $838 in 2025. Once used, these 60 days are permanently deducted from the lifetime total.
Beneficiaries can decline the use of LRDs for a particular stay to save them for a future, longer admission. If the 60 days are exhausted, any subsequent hospital stay exceeding 90 days in a benefit period requires the patient to pay 100% of the costs. The LRD mechanism is exclusively tied to the hospital inpatient benefit structure.
Why Lifetime Reserve Days Cannot Be Used for SNF Stays
The fundamental reason LRDs cannot be used for an SNF stay is the statutory separation of Medicare Part A benefits. Medicare treats the inpatient hospital benefit (acute care) and the SNF benefit (post-hospital rehabilitation) as two distinct services. The hospital benefit provides 90 covered days per benefit period, with LRDs available for days 91 through 150.
In contrast, the SNF benefit is strictly capped at 100 days per benefit period following the qualifying hospital stay. Unlike the hospital benefit, the SNF coverage structure does not include any provision for reserve days to extend this time limit.
Once a patient reaches the 100th day of SNF care, Medicare Part A SNF coverage is fully exhausted. Starting on day 101, the patient becomes fully responsible for 100% of the cost of their SNF care, as LRDs cannot be substituted to cover these expenses.
Financial Options After Medicare SNF Coverage Ends
When Medicare SNF coverage ends (after 100 days or due to lack of medical necessity), patients must transition to alternative payment methods for continued care.
Private Pay
One common option is private pay, using personal savings, retirement funds, or other out-of-pocket resources to cover the full daily rate. This option can quickly deplete financial assets due to the high cost of long-term care.
Medicaid
For individuals with limited income and assets, Medicaid is a government program that covers long-term nursing home care. Unlike Medicare, Medicaid is needs-based, requiring applicants to meet strict financial eligibility criteria that vary by state. Families often consult elder law attorneys to navigate the complex application and asset spend-down rules for qualification.
Long-Term Care Insurance
Long-Term Care Insurance is a private policy designed to cover services such as nursing home care, assisted living, or in-home care. The coverage provided is determined by the specific terms and benefit limits purchased by the individual.
Alternative Care Settings
Some patients may return home and utilize Medicare-covered home health services. Others may transition to a lower level of care, such as assisted living, that better suits their financial and medical needs.