“Medicare days” refer to the limited coverage periods established under Medicare Part A (Hospital Insurance). This coverage is structured around distinct “benefit periods” for inpatient hospital stays and skilled nursing facility (SNF) care. Understanding these limits is paramount because once the allotted days are exhausted, the financial responsibility for ongoing care shifts almost entirely to the patient. A benefit period begins the moment a beneficiary is formally admitted to a hospital or SNF. It ends only after the person has been out of the hospital or SNF for 60 consecutive days. If a new admission occurs before that 60-day break, the existing benefit period continues, and the patient resumes their coverage days and cost-sharing.
Exhausting Inpatient Hospital Coverage
Medicare Part A provides coverage for up to 90 days of inpatient hospital care within a single benefit period. The financial structure of this 90-day period is tiered, beginning with the patient paying a single deductible for the first 60 days of care, after which Medicare pays the full amount. As of 2024, that Part A deductible is $1,632, and the patient’s cost-share is zero for days 1 through 60 once the deductible is paid.
The cost structure changes significantly if the hospital stay extends beyond 60 days within the same benefit period. For days 61 through 90, the patient is responsible for a daily co-insurance payment, which is $408 per day in 2024. When a beneficiary reaches the 91st day of a continuous hospital stay, they begin to tap into a finite resource known as Lifetime Reserve Days.
Each Medicare beneficiary has a one-time bank of 60 non-renewable Lifetime Reserve Days (LRDs) that can be used only for inpatient hospital care after the 90-day benefit period is exhausted. These LRDs come with a daily co-insurance cost, set at $816 per day in 2024. Since these 60 days are a lifetime allotment, they do not reset with a new benefit period; once used, they are permanently gone.
If a patient uses all 90 standard benefit days and all 60 of their Lifetime Reserve Days, they reach a total of 150 days of Medicare-covered inpatient hospital care in that benefit period. At this point, Medicare Part A coverage for the hospital stay ceases completely. The patient becomes responsible for 100% of the hospital costs for every day after the 150th day until discharge. If the patient is discharged and remains out of the hospital or SNF for 60 consecutive days, a new benefit period starts. This makes the full 90-day coverage available again, although the Lifetime Reserve Days remain exhausted.
Exhausting Skilled Nursing Facility Coverage
The coverage limits for Skilled Nursing Facility (SNF) care under Medicare Part A operate on a more restrictive timeline than inpatient hospital coverage. To qualify for SNF coverage, the beneficiary must have had a prior qualifying hospital stay of at least three consecutive days as a formally admitted inpatient. The SNF care itself must be for skilled services, such as intravenous injections, physical therapy, or complex wound care, and not simply for custodial care.
Medicare Part A covers up to 100 days of skilled nursing care per benefit period, but financial responsibility changes after the first three weeks. The first 20 days of a Medicare-covered SNF stay are fully paid for by Medicare, meaning the patient pays zero co-insurance. This initial period of full coverage benefits beneficiaries needing short-term rehabilitation.
The situation changes dramatically from day 21 through day 100 of the SNF stay within the same benefit period. For this 80-day span, the patient is required to pay a daily co-insurance amount, which is $204.00 per day in 2024. This co-insurance can accumulate rapidly, creating a significant unexpected cost for the beneficiary.
Once a patient reaches day 101 of a SNF stay in a benefit period, Medicare Part A coverage ends entirely. Unlike the hospital benefit, there are no Lifetime Reserve Days to extend SNF coverage. The patient is then responsible for 100% of all subsequent SNF costs. Coverage can also end before day 100 if the patient no longer requires daily “skilled” care.
Navigating Costs After Medicare Day Limits
When Medicare Part A coverage for an extended hospital or skilled nursing stay is exhausted, beneficiaries must turn to alternative funding sources. The most common supplemental coverage is a Medigap policy, which is Medicare Supplement Insurance sold by private companies. Medigap plans pay for out-of-pocket costs incurred during the Medicare benefit period, such as the Part A co-insurance for hospital days 61-90 and the daily co-insurance for the Lifetime Reserve Days.
Medigap plans safeguard extended hospital stays by covering the co-insurance for the 60 Lifetime Reserve Days. Many Medigap plans also provide an extra 365 days of coverage for hospital stays once the 60 LRDs are used up, though this does not apply to SNF care. However, if all Medicare and Medigap hospital days are exhausted, the patient must assume full financial liability for their care.
For individuals with limited income and resources, Medicaid can act as the payer of last resort, especially for long-term care in a nursing home. Medicaid is a joint federal and state program that covers services not typically included in Medicare, such as long-term custodial nursing home care. Eligibility for Medicaid is determined by strict state-specific rules concerning income and countable assets, and it can cover the full cost of nursing home care once Medicare’s 100 days are depleted.
Patients who do not qualify for Medicaid and have exhausted their Medicare and Medigap coverage must resort to self-pay, using private funds, savings, or long-term care insurance policies. This situation necessitates proactive financial and discharge planning with the facility’s social worker or case manager. These professionals coordinate transitions to lower-cost settings or assist with applying for alternative government programs to manage the financial burden of a prolonged stay.