Medicare covers up to 90 days per benefit period in a long-term acute care hospital (LTCH), plus 60 additional “lifetime reserve days” you can use across your entire lifetime. That gives you a theoretical maximum of 150 days of coverage, though your out-of-pocket costs increase significantly after day 60.
How the 90-Day Benefit Period Works
Medicare Part A divides your LTCH coverage into tiers within each benefit period. For 2025, the breakdown looks like this:
- Days 1 through 60: You pay $0 per day after meeting the Part A deductible of $1,676.
- Days 61 through 90: You pay $419 per day in coinsurance.
- Days 91 and beyond: You tap into your lifetime reserve days at $838 per day.
Once you’ve used all 60 lifetime reserve days, Medicare stops paying entirely, and you’re responsible for the full cost. Those lifetime reserve days don’t reset. If you use 20 of them during one hospital stay, you have 40 left for the rest of your life.
A benefit period starts the day you’re admitted as an inpatient and ends when you’ve gone 60 consecutive days without receiving inpatient hospital care or skilled nursing facility care. After that 60-day gap, a new benefit period begins, which resets your 90 days of coverage (though not your lifetime reserve days). So if you’re discharged, stay out of the hospital for two full months, and then need readmission, you start fresh at day 1 with a new deductible.
What Makes an LTCH Different From Other Hospitals
Long-term acute care hospitals treat patients who need extended, intensive medical care, typically for complex conditions like respiratory failure, serious wounds, or multi-system infections. To qualify as an LTCH under Medicare, a facility must maintain an average patient stay longer than 25 days. That’s what distinguishes them from standard hospitals, where the average stay is closer to five days.
Not every admission to an LTCH receives the full payment rate. Medicare uses clinical criteria to determine whether a patient qualifies for the standard LTCH reimbursement. You generally need to meet one of two conditions: either you spent at least 3 days in an intensive care unit or coronary care unit at a regular hospital immediately before transfer, or you require ventilator support for at least 96 hours (four days) during your LTCH stay. Patients who don’t meet these thresholds may still be admitted, but Medicare pays the facility at a lower rate, which can affect the care options available to you.
What Happens If You’re Temporarily Transferred
LTCH patients sometimes need to be sent back to a regular hospital for a procedure or acute episode, then return to the LTCH. Medicare has specific rules for these interruptions that affect how your days are counted.
If you leave the LTCH and return within 3 days, Medicare treats the entire episode as one continuous stay. The LTCH receives a single payment covering everything, and any outpatient tests or inpatient care you received during those days away are the LTCH’s financial responsibility.
Longer interruptions follow a different set of thresholds depending on where you were transferred. If you spent between 4 and 9 days at a regular hospital, between 4 and 27 days at a rehabilitation facility, or between 4 and 45 days at a skilled nursing facility, Medicare still considers it one stay. Your days before and after the interruption are added together to calculate total length of stay. The days spent away at the other facility, however, are not counted toward your LTCH length of stay if no LTCH-related care was provided during that time.
If the interruption exceeds those thresholds, Medicare treats the readmission as a new, separate LTCH stay with its own payment.
How Medigap Can Extend Your Coverage
If you have a Medigap (Medicare Supplement) policy, it can significantly reduce what you pay out of pocket and even extend your hospital coverage. Every standardized Medigap plan, from Plan A through Plan N, covers Part A coinsurance. That means the $419 daily charge for days 61 through 90 and the $838 daily charge for lifetime reserve days would be covered by your supplement plan.
More importantly, every Medigap plan also provides up to 365 additional hospital days after your Medicare benefits are completely exhausted. This is a major safety net. Once you’ve used your 90 days and all 60 lifetime reserve days, Medicare pays nothing, but a Medigap plan picks up the cost for up to another full year of inpatient care. Without Medigap or another form of supplemental coverage, you’d be responsible for the entire daily hospital charge, which at an LTCH can run thousands of dollars per day.
Practical Cost Breakdown for a Typical Stay
The average LTCH stay runs about 25 to 30 days, which means most patients fall within the first tier of coverage. For a 30-day stay in 2025, you’d pay the $1,676 Part A deductible and nothing more for the daily charges. For a longer, more complex stay of 75 days, you’d pay the deductible plus 15 days of coinsurance at $419 per day, totaling $7,961 out of pocket.
A stay that stretches to 120 days gets expensive. You’d owe the deductible, $419 per day for days 61 through 90, and $838 per day for 30 lifetime reserve days. That adds up to roughly $38,286 before any supplemental insurance kicks in. This is where Medigap coverage or a Medicare Advantage plan with hospital benefits makes a significant financial difference.
If you’re enrolled in Medicare Advantage rather than Original Medicare, your LTCH coverage will vary by plan. Many Medicare Advantage plans cap your annual out-of-pocket spending, which can offer more predictable costs for extended stays. Check your plan’s specific benefit schedule, because copayment structures and coverage limits differ from the Original Medicare framework described here.