Medicare Part A, or Hospital Insurance, covers inpatient hospital stays, but this benefit is not limitless. When a person requires extended inpatient care, the financial responsibility gradually shifts from Medicare to the patient. Understanding this coverage structure is important, as a prolonged hospitalization can lead to significant out-of-pocket expenses. The system uses a defined unit of time and a separate pool of reserve days to establish the boundaries of Medicare’s financial support.
Defining the Medicare Hospital Benefit Period
Medicare Part A measures a beneficiary’s use of inpatient hospital services through the “Benefit Period.” This period determines coverage limits and cost-sharing responsibilities for inpatient care. A Benefit Period begins the day a patient is admitted as an inpatient to a hospital or a Skilled Nursing Facility (SNF).
The period continues until the beneficiary has been out of a hospital or an SNF for 60 consecutive days. If a person is discharged and then readmitted before those 60 days pass, the second hospitalization is considered part of the same Benefit Period. A single calendar year could potentially include multiple Benefit Periods, each requiring the patient to meet a new deductible.
Coverage and Costs During the Initial 90 Days
Within a single Benefit Period, Medicare Part A provides coverage for up to 90 days of inpatient hospital care. The financial structure for these 90 days is divided into two distinct phases. The first phase covers the initial 60 days of hospitalization.
During this first 60-day phase, the patient is responsible for paying a set deductible amount for the Benefit Period. After this deductible is met, Medicare pays the entire cost for the remaining days up to the 60th day.
If the hospital stay extends beyond the 60th day, the second phase begins. For days 61 through 90, the patient is required to pay a fixed daily coinsurance amount. Once the patient is discharged and a new Benefit Period begins after 60 days away from inpatient care, the full 90 days of coverage are available again.
Using Lifetime Reserve Days
When a hospital stay exceeds the initial 90 days within a single Benefit Period, Medicare offers a non-renewable pool of 60 “Lifetime Reserve Days” (LRDs). These days are a one-time allowance available to a beneficiary over their entire lifetime and do not renew with each new Benefit Period. They serve as a safety net for exceptionally long or catastrophic hospitalizations.
The use of LRDs begins automatically on the 91st day of an inpatient stay unless the patient specifically chooses to decline them. Utilizing these days comes with a significantly higher daily coinsurance payment than the amount charged for days 61 through 90.
Financial Responsibility After All Days Are Exhausted
The most significant financial shift occurs once a patient has used both the 90 days of standard coverage and all 60 of their Lifetime Reserve Days, totaling 150 covered days within a single Benefit Period. At this point, Medicare Part A coverage for the inpatient hospital stay stops entirely. The financial liability for every subsequent day of the hospital stay falls completely to the patient.
This means the patient becomes 100% responsible for the full cost of the hospital’s charges, which can be substantial. Since the daily rate for hospital services without insurance coverage is high, this quickly leads to a large financial burden. The hospital is typically required to notify the patient before their coverage runs out to prepare them for this financial transition.
Alternative Care and Coverage Options
When Medicare Part A hospital days are exhausted, patients and their families often must consider alternative payment and care options.
Medicare Supplement Insurance (Medigap)
Medicare Supplement Insurance, also known as Medigap, can provide a buffer against this high financial risk. Many Medigap plans cover the coinsurance amounts for the 61st through 90th days, the Lifetime Reserve Day coinsurance, and may even offer coverage for an additional 365 days of hospital care after Medicare benefits are completely exhausted.
Skilled Nursing Facility (SNF) Coverage
For continued recovery, a patient may be transferred to a Skilled Nursing Facility (SNF), which has a separate Medicare coverage structure. Medicare Part A covers up to 100 days of skilled care per Benefit Period under specific conditions, such as a qualifying prior three-day hospital stay.
Medicare Advantage and Medicaid
Medicare Advantage plans also act as an alternative, as they are required to cover everything Original Medicare does, but they often have an annual maximum out-of-pocket limit, which caps the beneficiary’s spending regardless of the length of the hospital stay. For individuals with limited income and resources, Medicaid may be an option to cover the significant costs of an extended stay in a nursing facility or hospital when other benefits are depleted.