A benefit period is the way
the Original Medicare program measures your use of inpatient hospital and skilled nursing facility (SNF) services. It begins on the day that you enter a hospital or SNF and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row. The benefit period is not tied to the calendar year. 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. There is no limit to the number of benefit periods you can have, or how long a benefit period can be.
Benefit periods also affect how much you may pay for your inpatient hospital or SNF stay. You must meet your Part A deductible at the beginning of each benefit period as well as pay a daily coinsurance depending on how many days you stay at the hospital or SNF during one benefit
period.
After you meet your Part A deductible at the beginning of the benefit period, the first 60 days of your inpatient hospital stay are covered with no daily coinsurance. Similarly, if you qualify for a Medicare-covered SNF stay, you will pay nothing for the first 20 days of your SNF stay within a benefit period.
In 2016, Original Medicare Part A costs for hospital and SNF stays are:
- Deductible: $1,288 for each benefit period
- Hospital coinsurance: $0 for the first 60 days of inpatient care each benefit period; $322 per day for days 61-90
- Skilled nursing facility coinsurance: $0 for the first 20 days of inpatient care each benefit period; $161 per day for days
21-100
Note: These figures are for Original Medicare only.
Medicare Advantage and Medigap reduce the coinsurance.
Let’s say you enter the hospital as an inpatient on May 1 and go home on May 15 (14 days in the hospital). If you need to go back to the hospital on June 30 (46 days out of the hospital) for 3 days, you are still in the same benefit period because you have not spent more than 60 days out of the hospital or SNF. You will also not have to pay another hospital deductible. In addition, since
you will be on days 15-18 of your hospital benefit, you will not have to pay any coinsurance either.
