If you have Original Medicare, it’s important to know how your visits to hospitals and skilled nursing facilities (SNFs) are measured.
Here are the details of a Medicare benefit period, how it can affect your Medicare Part A (hospital insurance) deductible and some realistic examples.
A benefit period is how Original Medicare measures your use of hospital and SNF services.1 It begins the day you're admitted as an inpatient in a hospital or SNF and ends when you haven't received any inpatient hospital care (or skilled care in an SNF) for 60 days in a row.2
Unlike other types of health insurance, the deductible for a Medicare benefit period is not based on the calendar year. Instead, you pay a separate deductible for each benefit period—meaning you could pay more than one deductible in the same year.
A benefit period also can affect how much you pay in total for your inpatient hospital or SNF stay. You must pay your Part A deductible at the beginning of each benefit period and possibly a daily coinsurance based on how many days you stay.
Here are the Part A costs for hospital and SNF stays for 2021:
- Deductible – $1,484 for each benefit period3
- Hospital coinsurance – $0 for the first 60 days of inpatient care each benefit period; $371 per day for days 61–90; $742 per each "lifetime reserve day" after day 90 for each benefit period (up to 60 days over your lifetime)4
- SNF coinsurance – $0 for the first 20 days of inpatient care each benefit period; $185.50 per day for days 21–100; all costs for each day after day 1005
To help you get a better understanding, here are 2 realistic examples:
Vivian was hospitalized with inpatient status from September 9–15 and paid her Part A deductible. She was rehospitalized on November 27 for the same injury, but since more than 60 days passed between her discharge in September, a new benefit period started and she owed another Part A deductible.
Richard was admitted as an inpatient to a hospital for knee surgery on March 1 and paid his Part A deductible. He was discharged on March 10, and a week later, he injured his shoulder. When Richard returned to the hospital for treatment on his shoulder, he did not owe another deductible because less than 60 days passed since his discharge.
Note: Vivian and Richard are fictitious characters and their stories are for educational purposes only.
Knowing how a benefit period works can help you understand your Medicare expenses. To learn more, check out this article on understanding Medicare's out-of-pocket costs.