Medicare Lifetime Reserve Days (LRDs) are a specific provision within Medicare Part A (Hospital Insurance) designed to provide extended coverage for beneficiaries requiring a long inpatient stay. LRDs act as a non-renewable bank of extra coverage, available only after the standard 90 days of Medicare-covered hospital days are exhausted. They offer a temporary financial bridge for beneficiaries facing prolonged acute illness or injury requiring continuous hospitalization. These days come with a high daily cost and, once used, are permanently deducted from the beneficiary’s lifetime balance.
Understanding the Standard Medicare Benefit Period
The coverage provided by Medicare Part A is organized around the benefit period, which is not tied to the calendar year. A benefit period begins the day a beneficiary is admitted as an inpatient to a hospital or skilled nursing facility (SNF). This period ends only after the beneficiary has remained out of a hospital or SNF for 60 consecutive days. If a patient is readmitted before that 60-day break, the stay is considered part of the same benefit period, and coverage limits do not reset.
During a single benefit period, Medicare Part A covers up to 90 days of inpatient hospital care. For the first 60 days, the beneficiary pays only the Part A deductible, which is \$1,676 in 2025. Days 61 through 90 require a daily coinsurance payment, set at \$419 per day in 2025, before reserve days are triggered. The benefit period structure requires that the deductible be paid again if a new benefit period begins.
Lifetime Reserve Days: Availability and Activation
Lifetime Reserve Days (LRDs) provide an additional 60 days of hospital coverage once the standard 90 days of coverage within a benefit period are exhausted. This is a one-time allotment that is permanently deducted from the beneficiary’s available balance across their lifetime. The days are not replenished, even if a new benefit period begins later in life.
The activation of LRDs is automatic, occurring immediately upon the 91st day of an inpatient hospital stay within a single benefit period. Hospital staff must issue a notice to the patient when they are nearing the end of the standard 90 days, informing them that LRDs will soon be used. While the use of LRDs is automatic, a beneficiary has the right to decline their use in writing to save them for a potential future illness. LRDs apply only to inpatient hospital services and do not extend coverage for a stay in a skilled nursing facility.
Costs Associated with Reserve Days
While Lifetime Reserve Days extend the duration of Medicare Part A coverage, they are not covered at the same rate as the initial 90 days. Utilizing an LRD requires the beneficiary to pay a daily coinsurance amount, which is a significantly higher financial obligation than the standard days. For instance, in 2025, the daily coinsurance amount for each LRD used is \$838.
This daily coinsurance amount is determined and adjusted annually by the Centers for Medicare & Medicaid Services (CMS). The cost is intended to cover the beneficiary’s share of the hospital expenses for that day, with Medicare paying the remaining covered costs. Many beneficiaries choose to enroll in a Medicare Supplement Insurance plan, known as Medigap, which can cover some or all of the Part A coinsurance amounts, including the high daily cost associated with the use of LRDs.
Consequences of Exhausting Reserve Days
The most significant consequence of using all 60 Lifetime Reserve Days is the complete cessation of Medicare Part A hospital coverage for any subsequent extended stay. Once the 60th LRD is used, Medicare coverage for that specific inpatient stay ends on the 151st day of hospitalization. The beneficiary then becomes solely responsible for 100% of the hospital charges thereafter.
This shift to full financial responsibility can result in substantial out-of-pocket costs and potential medical debt. Since these days are non-renewable, beneficiaries who have exhausted them have no backup for any future inpatient stay exceeding 90 days. Losing Part A coverage exposes patients to the full, non-discounted charges of a hospital.