What Happens When Medicare Hospital Days Run Out?

Medicare Part A helps cover inpatient hospital care, skilled nursing facility care, hospice care, and some home health services. While substantial, this coverage is not unlimited. Beneficiaries may face significant financial responsibilities if they exhaust their covered days, making it important to understand Medicare’s benefit structure and alternatives.

Medicare Part A Hospital Benefit Periods

Medicare Part A hospital coverage is structured around “benefit periods.” A benefit period begins the day a beneficiary is admitted as an inpatient to a hospital or skilled nursing facility (SNF). This period ends when the beneficiary has not received inpatient hospital care or skilled nursing facility care for 60 consecutive days. If a new inpatient admission occurs after 60 consecutive days, a new benefit period begins, and a new deductible may apply.

For 2025, after paying an inpatient hospital deductible of $1,676, Medicare covers the full cost of covered hospital services for the first 60 days of a benefit period. For days 61 through 90 of an inpatient stay within the same benefit period, a daily coinsurance of $419 applies.

Beyond the initial 90 days in a benefit period, beneficiaries have access to 60 “lifetime reserve days”. These days are non-renewable and can be used only once over a beneficiary’s entire lifetime. For each lifetime reserve day used in 2025, a daily coinsurance of $838 is required. Once these lifetime reserve days are exhausted, Medicare Part A no longer covers inpatient hospital costs for that benefit period or any future benefit periods.

Financial Responsibility After Medicare Hospital Limits

When a Medicare beneficiary exhausts all their covered inpatient hospital days, including their 60 lifetime reserve days, Medicare Part A ceases to provide coverage for the hospital stay. At this point, the financial responsibility for all subsequent inpatient hospital costs shifts entirely to the beneficiary. This transition can lead to substantial out-of-pocket expenses.

The costs that then fall solely on the patient include charges for a semiprivate room, meals, general nursing services, and medical supplies provided during the hospital stay. Beneficiaries become responsible for 100% of the hospital bill from the day their covered days run out.

Alternative Coverage and Care Options

When Medicare Part A hospital days are exhausted, exploring alternative coverage and care options is essential to manage costs and ensure continued access to necessary care. Several avenues exist to help beneficiaries manage these significant expenses.

Medicare Supplement Insurance (Medigap)

Medicare Supplement Insurance, also known as Medigap, can provide additional coverage for costs not paid by Original Medicare. All Medigap plans help cover Medicare Part A coinsurance and hospital costs for an additional 365 days after Medicare benefits are exhausted. Most Medigap plans also cover the Medicare Part A deductible. These policies, purchased from private companies, work with Original Medicare.

Medicaid

Medicaid, a joint federal and state program, assists low-income individuals with healthcare costs, including hospital care. If dually eligible for both Medicare and Medicaid, Medicaid may pay for Medicare’s deductibles, coinsurance, and copayments. For those requiring long-term care, Medicaid can cover nursing home care without a time limit, provided state-specific income and asset requirements are met.

Medicare Advantage Plans (Part C)

Medicare Advantage Plans (Part C), offered by private companies approved by Medicare, cover all benefits provided by Original Medicare Part A and Part B. Though Medicare Part A day limits apply, Medicare Advantage plans generally have an annual out-of-pocket maximum for covered services. For 2025, this maximum can be up to $9,350 for in-network services, which can limit a beneficiary’s financial liability once reached. These plans may also offer different cost-sharing or additional benefits not available with Original Medicare.

Discharge Planning

Discharge planning, provided by hospitals for inpatients, helps beneficiaries and their families determine the appropriate care setting and services needed after leaving the hospital. Working with hospital social workers, nurses, and other professionals during discharge planning helps identify suitable post-acute care options, such as skilled nursing facilities or home health care, which may be covered under different Medicare benefits or other programs.