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 they are subject to the 150 day psychiatric hospital reduction, i.e., when they have been in a psychiatric hospital during the 150 day period immediately preceding their 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 their 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.

An election not to use lifetime reserve days may be made by the beneficiary (or by someone acting on their 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 they elect 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 they elect not to use their 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).

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 their 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.

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 behalf of the beneficiary (e.g., relative, legal guardian, etc.). If an incapacitated beneficiary does not have other hospital insurance, and no other person agrees to pay the hospital, only the beneficiary's legal representative may file an election on their behalf.

An election not to use reserve days may be revoked in whole or in part (subject to the restrictions in C. above) while the patient is still in the hospital or within 90 days following discharge provided a claim has not been filed for Part B ancillary services furnished on the hospital days in question. The revocation must be submitted to the hospital in writing and made part of the patient's hospital record. If a beneficiary is incapacitated, any of the individuals who are permitted to sign the Request for Payment may file the revocation on the beneficiary's behalf within the 90 day period. However, an election not to use reserve days may not be revoked after the beneficiary dies.