What are Medicare benefit periods? How do benefit periods work?
Benefit periods are part of the payment structure of Original Medicare. They are meant to reduce excessively and unnecessarily long hospital stays. They only apply to Medicare Part A, which is your inpatient insurance.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
Benefit Period Schedule
A benefit period starts the day that you enter a hospital or skilled nursing facility, and it ends after you have had 60 days in a row without any inpatient care. Because of this structure, there can be multiple benefit periods in a calendar year.
Costs to You
Let’s look at the 2021 costs to you in a benefit period. For each inpatient stay you have a $1,484 Medicare Part A deductible. After that, there is a $0 per day co-pay for days one through 60 in the hospital.
If you are hospitalized for more than 60 days, you will have a co-pay of $371 per day for days 61 through 90. For days 91 and beyond, the copay jumps to $742 per day. Also, for days after day 90, you are using up your 60 lifetime reserve days. Once those are used, they do not get replenished in future benefit periods, and if you use up all 60 of your lifetime reserve days, then you will pay all costs for hospital stays of more than 90 days within a single benefit period.
Skilled Nursing Facility
If you move from the hospital to a skilled nursing facility care center, and this is a limited Medicare benefit – it is not custodial care, you will pay $0 as a co-pay for days one through twenty, and then you will pay $185.50 per day in co-insurance for each day of days 21 through 100. You are responsible for all costs for days 101 and beyond.
Real Life Examples
1) Here’s how benefit periods work in real life. Let’s say you entered the hospital on March 1st, and you went home on March 15th, making a 14-day hospital stay. If you then have to go back to the hospital on April 20th, you will be in the same benefit period because you haven’t had 60 days in a row without inpatient care.
When you go back to the hospital on April 20th, you will be on day 15 of your current benefit period, which means you will not have to pay the hospital deductible again, and your daily co-pays pick up with day 15.
2) Here’s a different example. Let’s say you were in the hospital from January 15 until January 20th, and then went to a skilled nursing facility until February twentieth, then you went home until you had to return to the hospital on May 5th.
You would now have a new benefit period. In this example, you would have to pay the hospital deductible of $1,484 for your May 5th hospital stay because you had 60 days in a row between hospital stays where you were not receiving any inpatient care. So that means your May 5th hospital stay begins a new benefit period.
Cover your Costs with a Medicare Plan
The deductibles, co-pays, and coinsurance in Medicare Part A benefits are some of what Medicare Supplements are designed to cover so that you don’t have unexpected, large medical bills after a hospital or skilled nursing facility stay.
Medicare Advantage plans, for the most part, do not use benefit periods because their payment structure is different. As always, when you’re looking at Medicare Advantage plans, it’s important to read the summary of benefits to understand how inpatient care is going to be covered by each plan.
If you have questions about how your current Medicare plan covers these Medicare Part A out-of-pocket risks, please feel free to give us a call at 877-312-1414. We’d be happy to schedule a free, no obligation Medicare plan consultation to go through your current plan and compare other options in your area to make sure that you are in a plan that is the best use of your premium dollars.
Leave a Reply