HI 00601.065 Lifetime Reserve Days

Under the lifetime reserve provision each beneficiary has available a total of 60 additional days of inpatient services. Payments for these additional days of care can be made under this provision after the beneficiary has used 90 days of inpatient hospital services in a benefit period (see HI 00401.340). However, if a beneficiary does not want to use his reserve days, he may elect not to have payment made under the reserve provision (and save his reserve for a later time).

A. Availability of reserve days

The reserve days are available for care in participating hospitals and for emergency services in nonparticipating hospitals.

A beneficiary's reserve days are not available to the extent that he is subject to the 150 day psychiatric hospital reduction, i.e., when he has been in a psychiatric hospital during the 150 day period immediately preceding his first day of entitlement to Part A benefits and is still in a psychiatric hospital on the first day of entitlement (see HI 00601.090).

The reserve days are also available to a beneficiary who uses up 190 days of inpatient psychiatric hospital care (see HI 00601.110) and remains in or reenters a psychiatric hospital.

A beneficiary will be deemed to have elected not to use his lifetime reserve to cover inpatient days for which the hospital's daily charge is equal to or less than the lifetime reserve days coinsurance amount (see HI 00601.560). Such days are treated as noncovered days.

B. Election not to use lifetime reserve days

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.

2. Retroactive election

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.

C. Period covered by election

An individual may elect not to use reserve days for only one period of consecutive days in each hospital stay. If an election not to use reserve days is made effective with the first day for which they are available, it may be terminated at any time. After termination of the election, all hospital days would be covered to the extent that reserve days are available. (Thus, an individual who has private insurance which covers hospitalization beginning with the first day after 90 days of benefits have been exhausted may terminate his election as of the first day not covered by the insurance plan.) If an election not to use reserve days is made effective beginning with any day after the first day for which reserve days are available, it must remain in effect until the end of that stay unless the entire election is revoked in accordance with E. below.

D. Election where beneficiary incapacitated

If the charges will be paid by other hospital insurance or if some other person agrees to pay the hospital, an election not to use reserve days may be filed by any of the individuals who may sign a Request for Payment on