What is a benefit period?
Coverage for care in hospitals and skilled nursing facilities is measured in “benefit periods.” In each benefit period, there are limits to the number of days Medicare will help pay for inpatient hospital, skilled nursing facility or hospice care. Once the limit is exceeded, the beneficiary is responsible for all charges for each additional day of care. A benefit period begins the day of admission to a hospital. It ends when the beneficiary has been out of a hospital or skilled nursing facility for 60 straight days, including the day of discharge. A beneficiary must pay the inpatient hospital deductible for each benefit period. The benefit period also ends for those in a skilled nursing facility who have not received skilled nursing care for 60 straight days. Once a benefit period has ended, a new benefit period begins and hospital and skilled nursing facility benefits are renewed. There is no limit to the total number of benefit periods.
A benefit period is the way that Original Medicare measures a person’s use of hospital and skilled nursing facility (SNF) services. (A skilled nursing facility is a nursing facility with the staff and equipment available to give skilled nursing care and/or skilled rehabilitation services such as changing sterile dressings and physical therapy.) A benefit period begins the day a person goes to a hospital or skilled nursing facility. The benefit period ends when the person hasn’t received any inpatient hospital care (or skilled care in an SNF) for 60 days in a row. If a person goes into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. The person must pay the inpatient hospital deductible for each benefit period.
