What Is a Medicare Benefit Period?

Caring.com staff asked...

What's an inpatient "benefit period" under Medicare Part A?

Expert Answer

How long Medicare Part A  covers inpatient care in a hospital or in a rehabilitation or skilled nursing facility, and how much it pays, depends on what's called a benefit period. A benefit period is a time frame that begins the first day a patient stays overnight in the hospital and continues until the patient's been out of the hospital for 60 consecutive days.

For any one benefit period, you pay a hospital deductible of $1,068 (in 2009). After that, Part A pays 100 percent of covered care for the first 60 days in the hospital. For more than 60 days hospitalization in the same benefit period, you pay a coinsurance cost of $267 per day up to day 90, and Part A pays the rest. If and when you begin a new benefit period, this payment schedule for the first 90 hospital days starts over again, with a new deductible and coinsurance.

If a hospitalization lasts more than 90 days within any one benefit period, you must pay $534 a day, with Part A paying the rest, for days 91 to 150. These are referred to by Medicare as reserve days. There are only 60 Medicare reserve days in a patient's lifetime. Once they're used up, you're responsible for the full cost of any hospital stay beyond 90 days. You're also responsible for the full cost of care once you've been in the hospital for more than 150 days.

For rehabilitation or skilled nursing-facility inpatient care, Part A covers up to 100 days during any one benefit period. For the first 20 covered days in a skilled nursing or rehabilitation facility, Part A pays the full cost; for the next 80 days, you're responsible for a co-payment of $133.50 per day.