An election not to use lifetime reserve days may be made by the beneficiary (or by
someone acting on his behalf) at the time of admission or at any time thereafter,
subject to the limitations on retroactive elections in (2) below.
Hospitals notify patients who have already used, or will use, 90 days of benefits
in a benefit period that they can elect not to use their reserve days for all or part of a stay. The notice is given when the
beneficiary has five regular coinsurance days left and is expected to be hospitalized
beyond that period. When the hospital discovers that the patient has fewer than five
regular coinsurance days left, it immediately notifies the patient of this option.
The hospital makes available an appropriate election statement or form to be included
in the patient's hospital record if he elects not to use reserve days.
(A Medicare beneficiary who is eligible for medical assistance under a State plan
is advised that such assistance will not be available if he elects not to use his
lifetime reserve days. However, this restriction does not apply when the beneficiary
is deemed to have elected not to use lifetime reserve days because the hospital charges
do not exceed the lifetime reserve days coinsurance amount (see a.above).
1. Election made prospectively
Ordinarily, an election not to use reserve days will apply prospectively. If the election
is filed at the time of admission, it may be effective with the first day of hospitalization
or with any day thereafter. If the election is filed later, it may be effective beginning
with any day after the day it is filed.
A beneficiary may, while in the hospital or within 90 days following his discharge,
retroactively elect not to use reserve days provided: (A) the beneficiary (or some
other source) offers to pay the hospital for any of the services not payable under
Part B; or (B) the hospital agrees to accept the retroactive election.