Medicare Part A covers inpatient services, but coverage is limited for extended hospital stays. When hospitalization is prolonged, beneficiaries rely on Lifetime Reserve Days (LRDs) to extend coverage and manage costs. LRDs are a non-renewable, one-time allocation designed to protect beneficiaries who require extended inpatient care beyond the standard benefit limits.
What Lifetime Reserve Days Are and When They Start
Lifetime Reserve Days are a finite pool of 60 extra days of inpatient hospital coverage provided under Medicare Part A. This allocation is given to a beneficiary once and does not renew, making it a lifetime resource intended for use during exceptionally long hospital stays. These days are automatically available to the beneficiary, but they are not activated until the standard coverage within a benefit period is exhausted.
A Medicare benefit period begins the day a person is admitted as an inpatient to a hospital and ends only after they have been out of the hospital or a Skilled Nursing Facility for 60 consecutive days. Within each new benefit period, Medicare Part A covers up to 90 days of inpatient care. The first 60 days of this period are covered after the beneficiary pays a single deductible, while days 61 through 90 require a daily co-insurance payment.
LRDs are triggered starting on day 91 of a continuous inpatient hospital stay within one benefit period. The patient has the option to elect not to use their LRDs, but if no such election is made, Medicare automatically applies these reserve days to cover the hospitalization cost. Since these days are a lifetime resource, the decision to apply them to an extended stay is significant.
The Cost of Using Reserve Days
Using Lifetime Reserve Days requires the beneficiary to pay a daily co-insurance amount, which is higher than the co-insurance for the preceding days of coverage. For example, in 2025, the daily co-insurance for an LRD is $838, which is the patient’s share of the cost for that day of hospital care. This payment structure is a form of cost-sharing, where the beneficiary pays a portion while Medicare covers the remainder of the daily hospital bill.
This daily cost contrasts with the standard benefit period structure that precedes it. For instance, in 2025, the co-insurance for days 61 through 90 of a hospital stay is $419 per day, which is half the cost of an LRD. The first 60 days of the benefit period, following the payment of the Part A deductible, require no daily co-insurance from the patient.
Many beneficiaries who have supplemental insurance, often called Medigap, may have their LRD co-insurance costs covered by their plan. Several Medigap plans are designed to pay the daily co-insurance for the lifetime reserve days. This coverage ensures that the safety net of LRDs remains financially viable for those requiring very long hospitalizations.
What Happens After They Run Out
Once a beneficiary has used all 60 of their Lifetime Reserve Days, they reach the absolute limit of their inpatient hospital coverage under Medicare Part A. At this point, the beneficiary is responsible for 100% of the cost of any subsequent days of inpatient hospital care within that benefit period. These costs can be substantial, as hospital services are among the most expensive components of healthcare.
If the patient remains hospitalized after exhausting their LRDs, they must either pay the full cost of the continuing inpatient stay out-of-pocket or rely on any other private insurance coverage they may hold. The care team may also explore options for discharge to a less intensive setting, such as a skilled nursing facility or home health care, if medically appropriate. The exhaustion of LRDs marks a financial threshold, eliminating any further Medicare coverage for that hospital stay.