What is a Medicare Benefit Period?

One of the most common questions people ask themselves is: What is a Medicare Benefit Period? It’s easy to assume that the benefit period is the duration during which Medicare will cover your care once you’re admitted to the hospital. However, that’s not how it works. It’s a concept that many people find rather difficult to comprehend, and that’s not the least surprising.

In this post, we’ll define what the Medicare benefit period refers to and how it affects your costs. Ultimately, you should be able to differentiate between Medicare benefit period and a calendar year.

Benefit Period Defined

The Medicare benefit period begins the day you enter a hospital or a skilled nursing facility (SNF) for care and ends when you’ve been out of hospital or a skilled nursing facility for 60 days in a row. For instance, if you leave the hospital on June 5 but are readmitted within 60 days of that date, say July 4, then you’re still within the same benefit period. However, if you go back in the hospital more than 60 days from the day you left, then you’re in a new benefit period. The major difference between being in different benefit periods is in the costs involved.

Things become a bit more complicated because any time you spend in a SNF (where you may go after being discharged from hospital for continuing care) also counts towards a benefit period but the out-of-pocket costs and rules are different. The expenses in benefit periods will likely differ depending on whether you’re enrolled in a Medicare Advantage (MA) plan or traditional Medicare. Regardless, it is important to be covered as having some sort of health insurance is always necessary.

Why is it Important?

The concept of benefit period is crucial because the Medicare Part A deductible is based on the benefit period rather than a calendar year.

Most other types of healthcare insurance (non-Medicare), base their deductible on the calendar year. Once you meet it, your health plan will cater for all or part of your costs for the remainder of the calendar year, but your deductible resets on the 1st of January. So, should you be admitted to a hospital from say December 27th to January 2nd. Most non-Medicare plans will require you to pay two deductibles.

But with original Medicare, that sort of scenario would still be part of a single benefit period, although you’ve been hospitalized within a period that spans two calendar years. As such, you’ll only pay your Medicare Part A deductible once.

However, there are situations where you’ll be required to pay your deductible twice in the same calendar year. For instance, if you’re hospitalized for a few days in February, that’s when the benefit period would start. If you’re discharged and go 60 days without going to a hospital or SNF, that benefit period ends. As a result, being hospitalized again in September enters you into a new benefit period, and you’ll have to pay another deductible before covers kick in again.

Bottom Line

With the tips mentioned, you should be able to answer the question: What is a Medicare benefit period? It’s important to note that Medicare places no limit on the number of benefit periods you can have in a year. However, you want to note the differences in deductibles while also knowing if you’re eligible in the first place for the age requirements and more prior to signing up for Medicare and other supplemental plans from a Medicare specialist.