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Toni:

Why did a hospital medical claims employee ask my husband Steven to sign a form stating that he is aware that he is now in his “lifetime reserve days”? He is waiting for a lung-heart transplant.

Steven went into the hospital in December of last year for congestive heart failure and discovered that his heart and lungs could no longer support him. The wait for this double transplant is taking longer than expected. I am concerned that the hospital will send him home or to a nursing home to wait and that he may not receive the correct medical care.

Please explain what Steven needs to do. He has Medicare with a Medicare Supplement Plan G, and he has had no issues with that plan. Thanks, Toni.

—Betsy from Birmingham, Ala.

Hi Betsy:

The hospital staff had Steven sign the form regarding lifetime reserve days because once he is past the inpatient hospitalization limit of 60 lifetime reserve days, then Medicare stops paying and the stay is his responsibility.

For 2026, Medicare Part A covers an inpatient hospital stay with a $1,736 deductible for days 1 through 60. (And yes, an inpatient hospital deductible of $1,736 can apply up to six times a year.) This includes a semi-private room and board, general nursing and miscellaneous services and supplies.

But if your Part A inpatient hospital stay is longer than 60 days, then for days 61 through 90 Medicare pays all but $434 per day. For days 91 and after, Medicare will pay all but $868 per day with the 60 lifetime reserve days to be used. Once the Medicare lifetime reserve days are used, then Part A’s inpatient hospital benefits are exhausted and you will pay all the cost of the remainder of the hospital stay without a Medicare Supplement. But because Steven has a Medicare Supplement Plan G, his remaining Part A inpatient hospital costs are paid for by the plan.

So Betsy, there is good news for you and Steven because he has a Medicare Supplement. There is a notice in the summary of benefits for a Medicare Supplement plan only — not a Medicare Advantage plan — regarding when Medicare’s lifetime reserve days are used and it states: “When your Medicare Part A hospital benefits are exhausted, the insurer stands in the place of Medicare and will pay whatever amount Medicare would have paid up to an additional 365 days as provided in the policy's ‘Core Benefits.’ During this time, the hospital is prohibited from billing you for the balance based on any difference between its billed charges and the amount Medicare would have paid.”

Thus Steven will have an additional 365 days of inpatient hospital benefits that only a Medicare Supplement insurance plan has and will pay. He will pay $0 for the additional 365 days.

It is truly fortunate that Steve has a Medicare Supplement. He and his doctors together can choose where to have his heart and lung transplants and select which skilled nursing facility he will stay in while recuperating. Readers enrolled in a Medicare Advantage plan should discuss lifetime reserve days with that plan’s customer service regarding extended in-patient hospital stays.

One more important thing, Betsy: If Steven’s Part D prescription drug plan does not cover his new transplant prescription drugs, then who will pay? He will! Always verify that his new prescriptions will be on his current Medicare Part D plan. Take your time and explore your Medicare prescription drug availability with your transplant physician’s office or transplant facility’s caseworker.

During a Toni Says Medicare consultation, we are careful to personalize your Medicare Part D planning because once you are enrolled you cannot change until the next Medicare Open Enrollment Period, which is October 15 through December 7. Toni’s new “Confused About Medicare” video series and Medicare Roadmap are available at www.tonisays.com.

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Toni King is an author and columnist on Medicare, Social Security and long-term care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.

©2026 Toni King. Distributed by Tribune Content Agency, LLC.

Copyright 2026 Toni King, Distributed by Counterpoint Media