When does a new Medicare Part A "benefit period" begin?

A Medicare Part A "benefit period" refers to the way Medicare calculates how much it pays of your covered inpatient hospital or skilled nursing facility stay, and how much you have to pay. You must pay a hospital inpatient deductible ($1,024 in 2008) for each benefit period, but then Medicare Part A pays the full cost of your covered inpatient care for 60 days. For each inpatient day over 60 days in any one benefit period, you must make co-payments. For covered skilled nursing facility inpatient stays, Medicare covers 100 days in each benefit period, with the patient paying a co-payment for days 21 through 100. When a new benefit period starts, you're responsible for a new deductible, but your coverage for a hospital or nursing facility stay starts over again, which means significant periods with no co-payments.

A benefit period begins the day you first enter the hospital or nursing facility for a particular injury or illness , and continues until you have been out of the hospital or nursing facility for 60 consecutive days. If you're in and out of the hospital or nursing facility while being treated for that original illness or injury, a single benefit period continues unless and until you are out for 60 days in a row. But if you need to become a hospital or nursing facility inpatient again because of a different injury or illness, the rule about 60 consecutive days out of the hospital doesn't apply. A new benefit period begins with the first day of an inpatient stay for each particular injury or illness.

Sometimes it's not always obvious that a new inpatient stay is not the result of the injury or illness that caused the prior inpatient stay. In that case, it's up to your doctors to make it clear to Medicare what the reason is for the second inpatient care. If you believe there may be some doubt about this question, make sure to discuss it with your doctors so that they can be clear on your medical records that your second period of inpatient care is not the result of the same injury or illness that required your first inpatient stay.