Explaining ‘lifetime reserve days’ in simple terms

on Apr 4, 2024

Toni:

Why did a hospital medical claims division employee ask my husband James to sign a form stating that he is aware that he is now in his “lifetime reserve days” while he was waiting for his lung/heart transplant?

He went into the hospital in December of last year for congestive heart failure only to discover that his heart and lungs can no longer support him. The wait for this double transplant is taking longer than expected. I am concerned that the hospital will send him home or to a nursing home to wait and he will not receive the correct medical care.

Please explain what James needs to do. He is covered by a Medicare Supplement Plan G, and he has had no issues with that plan. Thanks, Toni.

--Alice from Atlanta

Hi Alice:

The hospital staff had James sign the form regarding “lifetime reserve days” because once he is past the Inpatient Hospitalization 60 Lifetime Reserve days, then Medicare stops paying and the stay is his responsibility.

For 2024, Medicare Part A covers an inpatient hospital stay with a $1,632 deductible for days 1-60. Yes, an inpatient hospital deductible of $1,632 can happen 6 times a year. This includes a semiprivate room and board, general nursing and miscellaneous services and supplies.

If your Part A-Inpatient Hospital stay is longer than 60 days, then for days 61 through 90 Medicare pays all but $408 per day.

For days 91 and after, Medicare will pay all but $816 per day with the 60 “lifetime reserve days” to be used. Once the Medicare lifetime reserve days are used, then the “inpatient hospital benefits” are exhausted. You will pay all the costs of the remainder of the hospital stay. (James has a Medicare Supplement Plan G and his Part A-Inpatient Hospital costs are paid for by the plan.)

Alice, I have good news for James because he has a Medicare Supplement. There is a notice in the summary of benefits for a Medicare Supplement plan (not a Medicare Advantage plan) regarding when Medicare’s Lifetime Reserve Days are used and it states: NOTICE: When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy's "Core Benefits.” During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

So James will have an additional 365 days of “inpatient hospital benefits” that only a Medicare Supplement insurance plan has and will pay. James will pay $0 for the additional 365 days (except for his annual deductible in the new year).

What a blessing that James has a Medicare Supplement and he and his doctors together can choose where to have his heart and lung transplants and which skilled nursing facility he will select while recuperating. Readers enrolled in a Medicare Advantage plan should discuss “Lifetime Reserve Days” with that plan’s customer service regarding extended in-patient hospital stays.

Alice, if James’ Part D prescription drug plan does not cover his new transplant prescription drugs, then who will pay? James will! Please verify that his new prescriptions will be on his current Medicare Part D plan. Take your time and explore your Medicare prescription drug availability with your transplant physician’s office or transplant facility’s caseworker.

During a Toni Says Medicare consultation, we are careful to personalize your Medicare Part D planning because once enrolled you cannot change until the Medicare Annual Enrollment Period which is October 15 - December 7.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. The “Medicare Survival Guide Advanced” edition and her new “Confused about Medicare” video series are available at www.tonisays.com.