Medicare covers up to 60 days in a long-term acute care (LTAC) hospital during a single benefit period, but the actual number of days you receive payment depends on your medical condition, the hospital's documentation, and whether you meet Medicare's definition of medically necessary care.

A long-term acute care hospital treats patients who need intensive care for longer than a typical acute hospital stay — usually people recovering from surgery, severe infections, or conditions requiring mechanical ventilation. Medicare Part A (hospital insurance) pays for these stays, but only for days that meet specific medical criteria. The 60-day limit is not automatic; it applies only if your doctor and the hospital document that each day of care is medically necessary.

The actual payment depends on your diagnosis-related group (DRG), which is a classification that determines how much Medicare pays per day. Different conditions have different expected lengths of stay. If your stay exceeds what Medicare considers typical for your diagnosis, the hospital must justify each additional day with clinical documentation, or payment may be denied for those days.

Key Takeaways

  • Medicare Part A covers up to 60 days per benefit period in an LTAC hospital, but only for days the hospital documents as medically necessary.
  • Your diagnosis determines the expected length of stay; stays longer than the typical range for your condition require additional justification from your doctor.
  • You pay a daily coinsurance amount (currently $194.50 per day for days 1–60) after your Part A deductible is met, not a flat copay.
  • If your stay extends beyond 60 days, you are responsible for the full cost unless you have supplemental insurance or Medicaid coverage.
  • The benefit period resets 60 days after you leave the hospital, so a new stay can trigger a new 60-day benefit period.

What Counts as a Covered Day

Medicare does not pay for every day you spend in an LTAC hospital. The hospital must document that your condition requires the level of care that only an LTAC can provide — typically mechanical ventilation, complex wound care, intravenous medications, or intensive monitoring that cannot be done in a skilled nursing facility or at home.

Your doctor must write orders each day stating that continued hospitalization is medically necessary. If Medicare's medical review team (or a recovery audit contractor hired by Medicare) determines that a day did not meet this standard, the hospital may not be paid for that day, and you could be billed for it. This is rare but happens when a patient's condition improves faster than expected or when the documentation does not clearly support the level of care provided.

The hospital's coding department assigns your stay a DRG based on your primary diagnosis and any complications. This code determines the expected length of stay for your condition. If your actual stay is much longer, the hospital must submit additional documentation explaining why your case is more complex than typical.

How Your Coinsurance Works

You do not pay a flat copay for each day in an LTAC hospital. Instead, you pay a daily coinsurance amount after you have met your Part A deductible for the benefit period. The coinsurance amount changes each year; for 2024, it is $194.50 per day for days 1 through 60.

If your stay extends beyond 60 days, you are responsible for 100 percent of the hospital's charges. This can be thousands of dollars per day. Many people do not realize this limit exists until they receive a bill after discharge, so it is important to ask your hospital's billing department early in your stay how many days Medicare is expected to cover.

If you have a Medigap (supplemental insurance) policy, it may cover some or all of your coinsurance. If you have Medicaid, it may pay for days beyond 60. Check your policy documents or call your insurance company to understand what your coverage includes.

When a New Benefit Period Starts

Your Part A benefit period is not the same as a calendar year. A benefit period begins the day you enter a hospital or skilled nursing facility and ends 60 days after you leave. Once that 60-day period ends, a new benefit period begins if you are readmitted.

This means if you leave an LTAC hospital after 50 days, you have used 50 of your 60 covered days. If you are readmitted to any hospital within the next 60 days, you still have only 10 days of coverage left in that benefit period. However, if you stay out of the hospital for 60 days after discharge, a new benefit period starts, and you get a fresh 60 days of coverage.

Some people plan their care around this timeline. For example, if you know you will need another hospital stay, your doctor may try to schedule it after your current benefit period ends, so you have the full 60 days available.

What Happens If You Stay Longer Than 60 Days

If your medical condition requires care beyond 60 days, you have several options, but Medicare will not pay for additional hospital days. Your hospital's discharge planner will discuss alternatives with you and your family.

The most common next step is transfer to a skilled nursing facility (SNF), which Medicare covers for up to 100 days per benefit period if you meet the requirements — usually a hospital stay of at least three days first. An SNF provides less intensive care than an LTAC but more than you can get at home. Your coinsurance in an SNF is lower: $0 for days 1–20 and $194.50 per day for days 21–100.

If you do not meet SNF requirements or if you need care beyond 100 days, you may transition to home health care, hospice, or a long-term care facility (nursing home). Home health is covered by Medicare Part A if a doctor orders it and you are homebound. A nursing home is not covered by Medicare but may be covered by Medicaid if you meet income and asset limits.

How to Check Your Remaining Days

You can find out how many covered days you have left by calling Medicare at 1-800-MEDICARE (1-800-633-4227) or by logging into your Medicare account at Medicare.gov. Have your Medicare number ready.

Your hospital's billing department can also tell you how many days are expected to be covered based on your diagnosis. Ask them early — do not wait until discharge. If you disagree with Medicare's decision to deny payment for certain days, you have the right to appeal. The hospital can help you file an appeal, or you can do it yourself.

If you have a case manager or social worker at the hospital, they can also explain your coverage and help you plan for what happens after your 60 days end. This is especially important if your recovery is slower than expected.

Frequently Asked Questions

Does the 60-day limit reset if I go home for a few days and come back?

No. If you are discharged and readmitted within 60 days, you are still in the same benefit period and your remaining days are what you have left. The 60-day clock only resets after you have been out of the hospital for 60 consecutive days. A brief home visit does not reset the clock.

What if my doctor says I need to stay longer than 60 days?

Your doctor's medical opinion does not override Medicare's 60-day limit. However, if your doctor believes the stay is medically necessary, the hospital can appeal Medicare's decision to deny payment for days beyond 60. You should also ask whether you meet the requirements for a skilled nursing facility, which has a separate 100-day benefit.

Will I get a bill for days Medicare does not cover?

Possibly. If Medicare denies payment for a day because it was not medically necessary, the hospital may bill you. However, hospitals must follow strict rules about billing patients for denied days. If you believe you were billed unfairly, you can file a complaint with your state's health department or with Medicare.

Does my Medigap insurance cover days beyond 60?

Some Medigap plans cover coinsurance for days 1–60, but most do not cover days beyond 60 because Medicare does not cover them. Check your policy or call your insurance company. Medicaid may cover additional days if you are enrolled in both Medicare and Medicaid.

How do I know if an LTAC hospital is the right place for me?

Your doctor and hospital discharge planner will recommend an LTAC if you need intensive care that cannot be provided in a skilled nursing facility or at home. Ask them to explain why an LTAC is necessary and how long they expect your stay to be. You have the right to ask questions and to seek a second opinion.