Question and Answer

Can you explain what a benefit period is?

While reading about my Medicare benefits, I came across the term benefit period. What does that mean?

A benefit period (sometimes called a spell of illness) is the way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you enter a hospital or skilled nursing facility (SNF) and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row.

If you go into the hospital or SNF after one benefit period has ended (more than 60 days after you left), a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There is no limit to the number of benefit periods you can have or to the length of an individual benefit period.

For example, if enter the hospital as an inpatient on May 1st and go home on May 15th (14 days in the hospital), but you need to go back into the hospital on June 30th (after 46 days out of the hospital), you are still in the same benefit period. You do not have to pay another hospital deductible and, since you will be on day 15 of your hospital benefit, you will not have to pay any coinsurance.

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