How many days is considered in a "benefit period" ?

2 answers | Last updated: Sep 14, 2017
Don rattan asked...

If a patient has been in and out of hospital but is home for 60 consecutive days, I understand a new benefit period begins. However, how many days does the patient get at the start of a new benefit period and do they get them all at once?

Expert Answers

Under Medicare Part A, you begin an entirely new, full benefit period as soon as you have been out of the hospital and a skilled nursing or rehabilitation facility for 60 consecutive days. For each new benefit period, you pay a hospital deductible of $1,024 (in 2008). After that, Part A pays 100 percent of covered care for the first 60 days in the hospital. If you're in the hospital more than 60 days in a single benefit period, you have to pay a coinsurance of $256 per day for day 61 through day 90; Part A pays the rest of the bill for those days.

If your hospitalization lasts more than 90 days, you must use what are known as "reserve days," for which you'd pay $512 a day, with Part A paying the rest of covered charges for those days. But, there are only a total of 60 reserve days in a patient's lifetime. Once one of these reserve days is used, it's gone forever. And when all 60 have been used, you'd be responsible for the full cost of any hospital stay beyond 90 days in any benefit period.

Community Answers

Jenandabby2 answered...

I am 55 years old and already have medicare a and b. I also have private insurance, which is paid by my employer. In 1993, I was diagnosed with Legionaries Disease and completely and totally disabled from that time. I now have to have 2 hip replacements, and 2knee replacements, due to steroids given to me on each of about 15 hospital stays. I live alone and must have someone come to my home each day, and spend about 3 or 4 hours until I can get up and moving without the chance of having an accident or fall. I will have each joint replacement 6 months apart, beginning 6-15-2010. Will Medicare pay for a temporary caregiver after each of these surgeries, so I can remain in my home? If so, what process do I have to follow to obtain these services?